NEW YORK (Reuters Health) – The lipid-modifying effects of rosuvastatin (Crestor: AstraZeneca) are stronger than atorvastatin (Lipitor; Pfizer) in patients with an acute coronary syndrome (ACS), according to new data from the LUNAR Trial.
Patients with ACS are recommended for early aggressive LDL cholesterol-lowering therapy. The LUNAR Trial involved 825 adults with coronary artery disease who were hospitalized for ACS within 48 hours of first symptoms. They were randomly allocated to once-daily rosuvastatin 20 or 40 mg or atorvastatin 80 mg for 12 weeks.
According to a report online February 23 in the American Journal of Cardiology, all three treatments were well tolerated over the 12-week study period.
The efficacy of rosuvastatin 40 mg in lowering LDL cholesterol was significantly greater than that of atorvastatin 80 mg (46.8% vs 42.7% decrease; p=0.02). LDL lowering efficacy was similar between rosuvastatin 20 mg and atorvastatin 80 mg.
Increases in healthy HDL cholesterol were also significantly greater with rosuvastatin 40 mg (11.9%; p<0.001) and rosuvastatin 20 mg (9.7%; p<0.01) than with atorvastatin 80 mg (5.6%).
Rosuvastatin 40 mg was also significantly more effective than atorvastatin 80 mg in improving “several other important lipid parameters,” the study team reports, whereas the effects of rosuvastatin 20 mg on these parameters were generally in line to those of atorvastatin 80 mg.
The finding that rosuvastatin 20 mg was as effective as atorvastatin 80 mg in decreasing LDL cholesterol with a similar safety profile suggests that this dose of rosuvastatin might be considered an alternative to atorvastatin 80 mg in patients with ACS, the authors say.
In an email to Reuters Health, study investigator Dr. Bertram Pitt from University of Michigan School of Medicine in Ann Arbor said, “The study was prompted by the results of the MIRACL trial of atorvastatin in patients with an acute coronary syndrome. Since rosuvastatin had been suggested to be a more potent lipid lowering drug than atorvastatin, it was felt important to compare the 2 drugs in the setting of an acute coronary syndrome.”
“Our results suggest that in fact rosuvastatin is a more efficacious lipid lowering agent than atorvastatin in these patients. However, it would be necessary to perform a far larger scale prospective randomized study evaluating cardiovascular outcomes before reaching any final conclusions as to the efficacy and safety of either of these drugs under these circumstances.”
The LUNAR Trial was funded by AstraZeneca LP, Wilmington, Delaware, and Dr. Pitt has served as a consultant to the company, as well as to Merck, Novartis, Pfizer, Bayer, Boehringer Ingelheim, Forest Laboratories, and Takeda.
SOURCE:
Am J Cardiol 2012.
