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Wei CR, Lakhdhir F, Rawat A, Isaak AK, Riaz A, Al Omari M, Bandaru RR, Amin A. Comparison of the Efficacy of Atorvastatin with Rosuvastatin in Preventing Cardiovascular Events Among Patients With Cardiovascular Disease: A Meta-Analysis. Cureus 2023; 15:e50421. [PMID: 38222118 PMCID: PMC10784709 DOI: 10.7759/cureus.50421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
The aim of this study was to assess and compare the efficacy of atorvastatin with rosuvastatin in preventing cardiovascular events among patients already diagnosed with cardiovascular disease (CVD). We performed this systematic review and meta-analysis as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Two investigators independently searched online databases, including PubMed, the Cochrane Library, and the Excerpta Medica database (Embase), from the inception of databases until November 2023. The primary outcome assessed in the meta-analysis included cardiovascular mortality and a composite of cardiovascular events. Other outcomes included myocardial infarction and stroke. A total of four studies were selected for our meta-analysis. A total of 7,378 patients were enrolled, including 3,721 in the atorvastatin group and 3,657 in the rosuvastatin group. Pooled analysis showed that the incidence of composite cardiovascular events was not significantly different in patients receiving atorvastatin and patients receiving rosuvastatin (risk ratio (RR): 0.93, 95% confidence interval (CI): 0.79 to 1.09, p-value: 0.38, I-square: 0%). Pooled analysis showed that the risk of cardiovascular mortality was not significantly different between the two study groups (RR: 0.96, 95% CI: 0.51 to 1.81, p-value: 0.93, I-square: 0%). In conclusion, our meta-analysis, based on four selected studies, found no significant disparities in composite cardiovascular events, cardiovascular mortality, myocardial infarction, or stroke between patients administered atorvastatin and those receiving rosuvastatin. This outcome underscores the comparable efficacy of these statins in mitigating cardiovascular risks, highlighting their clinical equipoise in the realm of secondary prevention.
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Affiliation(s)
- Calvin R Wei
- Research and Development, Shing Huei Group, Taipei, TWN
| | - Fahad Lakhdhir
- Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Dehradun , IND
| | - Abraham K Isaak
- Telemetry, Sharp Memorial Hospital, San Diego, USA
- Internal Medicine, Orotta School of Medicine and Dentistry, Asmara, ERI
| | - Areeba Riaz
- Medicine, Quiad-e-Azam Medical College, Bahawalpur, PAK
| | | | | | - Adil Amin
- Cardiology, Pakistan Navy Ship (PNS) Shifa, Karachi, PAK
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Qasim S, Kalsoom S, Shahzad M, Bukhari IA, Vohra F, Afzal S. Rosuvastatin Attenuates Rheumatoid Arthritis-Associated Manifestations via Modulation of the Pro- and Anti-inflammatory Cytokine Network: A Combination of In Vitro and In Vivo Studies. ACS OMEGA 2021; 6:2074-2084. [PMID: 33521447 PMCID: PMC7841959 DOI: 10.1021/acsomega.0c05054] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/04/2021] [Indexed: 05/23/2023]
Abstract
The current investigation employed rosuvastatin for evaluation as an antiarthritic agent by in vitro and in vivo studies. In vitro studies comprised egg albumin and bovine serum albumin protein denaturation assays along with membrane stabilization assays, while in vivo studies comprised formaldehyde and complete Freund's adjuvant (CFA)-provoked arthritis. The antioxidant potential was estimated via DPPH free radical scavenging and ferric reducing assays. Rosuvastatin significantly inhibited heat-provoked protein denaturation of egg albumin and bovine serum in a concentration-dependent way with the highest inhibition of 1225 ± 9.83 and 82.80 ± 4.03 at 6400 μg/mL. The percentage protection of the RBC membrane from hypotonicity-prompted lysis was found to be 80.67 ± 2.7. Rosuvastatin promisingly subdued formaldehyde-provoked arthritis, with maximum reduction (65.47%) of the paw volume being observed at a dose of 40 mg/kg. Rosuvastatin also significantly (p < 0.001) attenuated arthritis induced by CFA injection by reducing the paw volume and arthritic index. The reduction in the body weight due to CFA injection was also preserved by rosuvastatin treatment. Hematological and biochemical changes due to arthritis induction by CFA injection were also maintained near normal values by rosuvastatin. The histopathological and radiographic investigation also revealed the protective effect of rosuvastatin on preventing structural changes. Gene expression of IL-1β, TNF-α, and IL-6 was reduced, while IL-4 and IL-10 levels were elevated by rosuvastatin in comparison to those for the disease control group. Concentration-dependent antioxidant potential was shown by rosuvastatin. Thus, rosuvastatin possesses a notable antiarthritic potential as evidenced via in vitro and in vivo studies.
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Affiliation(s)
- Sumera Qasim
- College of Pharmacy, Jouf University, Sakaka, Aljouf 2014, Saudi Arabia
| | - Saima Kalsoom
- SA-CIRBS International Islamic University, Islamabad 44000, Pakistan
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore 54590, Pakistan
| | - Ishfaq Ali Bukhari
- Department of Pharmacology, College of Medicine, King Saud University Riyadh, Riyadh 11451, Saudi Arabia
| | - Fahim Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sibtain Afzal
- Immunology Research center, College of Medicine, King Saud University Riyadh, Riyadh 11451, Saudi Arabia
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Roy D, Mahapatra T, Manna K, Kar A, Rana MS, Roy A, Bose PK, Banerjee B, Paul S, Chakraborty S. Comparing effectiveness of high-dose Atorvastatin and Rosuvastatin among patients undergone Percutaneous Coronary Interventions: A non-concurrent cohort study in India. PLoS One 2020; 15:e0233230. [PMID: 32428019 PMCID: PMC7237007 DOI: 10.1371/journal.pone.0233230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Atorvastatin-80mg/day and Rosuvastatin-40mg/day are the commonest high-dose statin (3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors) regimes for post-PCI (Percutaneous Coronary Interventions) patients to lower (by ≥50%) blood low-density-lipoprotein cholesterol (LDL-C). Dearth of conclusive evidence from developing world, regarding overall safety, tolerability and comparative effectiveness (outcome/safety/tolerability/endothelial inflammation control) of Rosuvastatin over Atorvastatin in high-dose, given its higher cost, called for an overall and comparative assessment among post-PCI patients in a tertiary cardiac-care hospital of Kolkata, India. METHODS A record-based non-concurrent cohort study was conducted involving 942 post-PCI patients, aged 18-75 years, on high-dose statin for three months and followed up for ≥one year. Those on Atorvastatin-80mg (n = 321) and Rosuvastatin-40mg (n = 621) were compared regarding outcome (death/non-fatal myocardial infarction: MI/repeated hospitalization/target-vessel revascularisation/control of LDL and high-sensitivity C-reactive protein: hsCRP), safety (transaminitis/myopathy/myalgia/myositis/rhabdomyolysis), tolerability (gastroesophageal reflux disease: GERD/gastritis) and inflammation control adjusting for socio-demographics, tobacco-use, medications and comorbidities using SAS-9.4. RESULTS Groups varied minimally regarding distribution of age/gender/tobacco-use/medication/comorbidity/baseline (pre-PCI) LDL and hs-CRP level. During one-year post-PCI follow up, none died. One acute MI and two target vessel revascularizations occurred per group. Repeated hospitalization for angina/stroke was 2.18% in Atorvastatin group vs. 2.90% in Rosuvastatin group. At three-months follow up, GERD/Gastritis (2.18% vs 4.83%), uncontrolled hs-CRP (22.74% vs 31.08%) and overall non-tolerability (4.67% vs. 8.21%) were lower for Atorvastatin group. Multiple logistic regression did show that compared to Atorvastatin-80mg, Rosuvastatin-40mg regime had poorer control of hs-CRP (A3OR = 1.45,p = 0.0202), higher (A3OR = 2.07) adverse effects, poorer safety profile (A3OR = 1.23), higher GERD/Gastritis (A3OR = 1.50) and poorer overall tolerability (A3OR = 1.50). CONCLUSION Post-PCI high dose statins were effective, safe and well-tolerated. High dose Rosuvastatin as compared to high dose Atorvastatin were similar in their clinical efficacy. Patients treated with Atrovastatin had significantly lower number of patients with hs-CRP (high-sensitivity C-reactive protein)/C-reactive protein (CRP) level beyond comparable safe limit and relatively better tolerated as opposed to Rosuvastatin-40mg.Thus given the lower price, Atorvastatin 80mg/day appeared to be more cost-effective. A head-to-head cost-effectiveness as well as efficacy trial may be the need of the hour.
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Affiliation(s)
- Debabrata Roy
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
- * E-mail:
| | - Tanmay Mahapatra
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, West Bengal, India
| | - Kaushik Manna
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Ayan Kar
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Md Saiyed Rana
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Abhishek Roy
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Pallab Kumar Bose
- Department of Cardiology, Narayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Barnali Banerjee
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, West Bengal, India
| | - Srutarshi Paul
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, West Bengal, India
| | - Sandipta Chakraborty
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, West Bengal, India
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Colivicchi F, Gulizia MM, Franzini L, Imperoli G, Castello L, Aiello A, Ripellino C, Cataldo N. Clinical Implications of Switching Lipid Lowering Treatment from Rosuvastatin to Other Agents in Primary Care. Adv Ther 2016; 33:2049-2058. [PMID: 27671328 PMCID: PMC5083763 DOI: 10.1007/s12325-016-0412-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Indexed: 12/22/2022]
Abstract
Introduction Switching from any statin to another non-equipotent lipid lowering treatment (LLT) may cause a low-density lipoprotein cholesterol increase and has been associated with a higher probability of negative cardiovascular outcomes. The aim of the study was to assess the impact of switching from rosuvastatin to any other LLT on clinical outcomes in primary care. Methods This was a retrospective analysis based on data from IMS Health Longitudinal Patient Database, which is a general practice database including information of more than 1.0 million patients representative of the Italian population by age, and medical conditions. Patients that started on rosuvastatin (10–40 mg/day) between January 2011 and December 2013 were considered. The date of the first prescription was defined as the index date (ID). The observation period lasted from the ID to September 2015 or until LLT discontinuation, or the occurrence of an acute myocardial infarction (AMI), or death. Results The primary end point of the study was the occurrence of an AMI during the observation period. The final study population included 10,368 patients. During the observation period, 2452 (23.6%) patients were switched from rosuvastatin to another LLT. The majority of patients (55.6%) were switched to atorvastatin, followed by simvastatin (24.9%), simvastatin/ezetimibe combination (10.0%) and other statins (9.5%). Female gender (HR, hazard ratio, 1.10, 95% CI, confidence interval, 1.02–1.19, p = 0.04) and the presence of chronic kidney disease (HR 1.47, 95% CI 1.16–1.86, p = 0.05) were associated with a higher probability of switch. During the observation period, 113 patients experienced an AMI (incidence of 6.7 AMI/1000 patient-years). Multivariate analysis with Cox proportional hazards method, including switching as a time-dependent covariate, demonstrated that changing from rosuvastatin to another LLT was an independent predictor of AMI (HR 2.2, 95% CI 1.4–3.5, p = 0.001). Conclusion We conclude that switching from rosuvastatin to another non-equipotent LLT may impart an increased risk of AMI and should be avoided. Funding AstraZeneca SpA.
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Affiliation(s)
- Furio Colivicchi
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | | | | | - Giuseppe Imperoli
- Internal Medicine Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Lorenzo Castello
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Alessandro Aiello
- Cardiology Division, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
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Cai G, Zhang B, Shi G, Weng W, Yang L, Xue S. Endothelial lipase genetic polymorphisms and the lipid-lowering response in patients with coronary artery disease on rosuvastatin. Lipids Health Dis 2016; 15:148. [PMID: 27600285 PMCID: PMC5012091 DOI: 10.1186/s12944-016-0295-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/27/2016] [Indexed: 11/12/2022] Open
Abstract
Background Endothelial lipase (EL) plays an important role in the regulation of lipid metabolism by reducing the high density lipoprotein cholesterol (HDL-C) levels and inducing the macrophages to take up native low density lipoprotein cholesterol (LDL-C). Our purpose was to investigate the impact of EL genetic polymorphisms on the lipid-lowering effects of rosuvastatin in Chinese coronary artery disease (CAD) patients. Methods One hundred twenty-one unrelated CAD patients, who underwent the treatment with rosuvastatin (10mg/day) for four to eight weeks, were enrolled in this study. Before and after treatment, serum lipids levels were measured. Genotypes of EL 2037T/C and 2237 G/A polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Results Patients with EL 2037C allele (CC + CT) had significantly lower LDL-C levels than those with TT genotype (CC + CT: 2.60 ± 0.74 mmol/l; TT: 2.90 ± 0.87 mmol/l; P = 0.047), before rosuvastatin treatment. No significant differences between baseline lipid levels and the EL 2237G/A genotypes were observed. After treatment with rosuvastatin, total cholesterol (TC), high triglyceride (TG) and LDL-C levels decreased from baseline, on average, by 23.09 % (4.59 ± 0.96 mmol/l to 3.47 ± 0.83 mmol/l), 6.36 % (2.01 ± 1.18 mmol/l to 1.68 ± 1.16 mmol/l), 32.48 % (2.77 ± 0.83 mmol/l to 1.79 ± 0.62 mmol/l), respectively (all P < 0.05) in all patients. While changes in HDL-C levels did not reach statistical significance. No significant effects of EL 2037T/C or 2237G/A polymorphism were observed on lipid-lowering effects of rosuvastatin. Conclusions EL 2037T/C and 2237 G/A polymorphisms might not affect the lipid-owing effects of rosuvastatin in Chinese CAD patients. Electronic supplementary material The online version of this article (doi:10.1186/s12944-016-0295-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu Province, China.
| | - Bifeng Zhang
- Department of Pathology and Molecular Medicine, McMaster University, Ontario, Canada
| | - Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu Province, China
| | - Weijin Weng
- Department of Cardiology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu Province, China
| | - Liping Yang
- Department of Cardiology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu Province, China
| | - Sheliang Xue
- Department of Cardiology, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu Province, China
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