Rosuvastatin-for the Control of LDL Cholesterol.

<h2 id="background">Background:</h2><ul><li>Vascular diseases are the leading cause of death. Hypercholesterolemia is a cardiovascular risk factor and it also underlies the etiopathogenesis of atherosclerosis.</li><li>Hence, itis essential to decrease the risk of vascular complications by reducing LDL cholesterol (LDL-C) to the recommended goals.</li><li>Despite this, due to insufficient intensification of lipid-lowering treatment, current LDL-C control even in high and very high risk patients is scarce.</li></ul><h2 id="aim">Aim:</h2><p>This review shows the importance of intensive rosuvastatin-based lipid-lowering therapy and its place in clinical practice.</p><h2 id="observation">Observation:</h2><h3>Current Situation of Lipid Control:</h3><ul><li>The SANTORINI study included more than 9000 patients at high and very high vascular risk. Overall, only 20.1% patients achieved LDL-C goals.</li><li>The use of lipid-lowering drugs was suboptimal, with only 4.5% using proprotein convertase<br>subtilisin/kexin type 9 inhibitors (PCSK9i), 24% combination therapy, and 21.8% not receiving any treatment.</li><li>The mean LDL-C concentration in high-risk patients was 93 mg/dL, and in very high-risk patients it was 78 mg/dL (Figure 1).</li></ul><p>Figure 1: Proportion of patients that achieve LDL-C targets and proportion of patients using lipid lowering drugs in the SANTORINI study according to the presence of vascular disease.</p><figure class="image"><img style="aspect-ratio:1026/553;" src="https://cdn.megawecare.com/GHBY/Internal-Images/lipoprotein-cholestrol.webp" width="1026" height="553"></figure><h3>Role of Rosuvastatin in the Control of Cholesterol and the Reduction of Vascular Events:</h3><p>Rosuvastatin is a relatively hydrophilic, potent and highly selective statin for the enzyme 3-hydroxy-3-methylglutaryl-CoA reductase which significantly reduces cholesterol synthesis.</p><p>Rosuvastatin undergoes limited metabolism, only 10% is metabolized by cytochrome P450, showing low risk of interactions with other drugs.</p><h3>STELLAR study:</h3><ul><li>Showed Rosuvastatin was the most powerful statin, since it reduced LDL-C by 46-55%, compared to 37-51% with atorvastatin 10-80 mg, 28-39% with simvastatin 10-40 mg, and 20-30% with pravastatin 10-40 mg in 6 weeks.</li><li>Rosuvastatin increased HDL cholesterol by 8-10% (vs. 2-6%, 5% and 3-6%, respectively) and decreased triglyceride levels by 20-26% (vs. 20-28%, 12-15% and 8-13%, respectively)</li></ul><h3>VOYAGER study:</h3><ul><li>Apooled analysis of 32,258 individual patients of studies comparing the efficacy of rosuvastatin with that of atorvastatin or simvastatin showed results similar to Stellar.</li></ul><h3>Meta-analysis:</h3><ul><li>50 studies, with a total of 51,956 patients, showed superiority of rosuvastatin as compared to other statins proving it to be the most potent statin.</li></ul><h3>JUPITER Study:</h3><ul><li>Rosuvastatin showed significant reduction in mortality from any cause (Figure 2).</li><li>Benefits of rosuvastatin are found similar across spectrum of patients since, the results are consistent in different sub groups of patients and independent of age, sex, patient’s baseline cardiovascular risk and presence of diabetes or chronic kidney disease.</li></ul><p>Figure 2. Effect of rosuvastatin vs. placebo on main clinical outcomes in the JUPITER trial.</p><figure class="image"><img style="aspect-ratio:1065/511;" src="https://cdn.megawecare.com/GHBY/Internal-Images/jupiter-trail.webp" width="1065" height="511"></figure><h3>HOPE-3 Study:</h3><ul><li>12,705 patients without previous cardiovascular disease but with an intermediate cardiovascular risk, with median follow-up of 5.6 years, was associated with a significant reduction of 24% (HR 0.76, p = 0.002) in the risk of MACE.</li><li>Reduction of 35%, 30%, 32% in the risk of myocardial infarction (HR 0.65); stroke (HR 0.70) and need for revascularization (HR 0.68) respectively with rosuvastatin.</li></ul><h3>Role of Rosuvastatin-Based Combination Lipid-Lowering Therapy:</h3><ul><li>All the studies showed greater reductions in LDL-C and a greater degree of achievement of the objectives set by the clinical practice guidelines with the combination of rosuvastatin and ezetimibe, without increasing the risk of side effects (Table 1).</li></ul><p>Table 1. Effect of the rosuvastatin/ezetimibe combination on LDL cholesterol in phase 3.</p><figure class="image"><img style="aspect-ratio:1026/553;" src="https://cdn.megawecare.com/GHBY/Internal-Images/lipoprotein-cholestrol.webp" width="1026" height="553"></figure><h2 id="conclusion">Conclusion</h2><ul><li>To decrease the risk of vascular complications, it is essential to reduce LDL-C to the<br>recommended targets, which is currently very poorly controlled.</li><li>It is essential to prescribe appropriate lipid-lowering treatment with specific patient needs to improve LDL-C control, especially in high/very high-risk patients.</li></ul><p>Rosuvastatin, alone or combined with ezetimibe, provides intensive reductions in LDL-C, with a low risk of side effects and a lower cost, which is associated with a lower risk of vascular complications, both in patients without previous vascular disease, and in those with established atherosclerotic vascular disease.</p>

CARDIOLOGY UPDATES ISSUE 3 2024

<ul><li><a href="#background">Background</a></li><li><a href="#aim">Aim</a>&nbsp;</li><li><a href="#observation">Observation</a></li><li><a href="#conclusion">Conclusion</a></li></ul>

Rosuvastatin-for the Control of LDL Cholesterol.

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