[Click! Health] How to Choose Treatments for Patients with Atherosclerotic Cardiovascular Disease

Results verifying the long-term efficacy and safety of rosuvastatin and atorvastatin, representative drugs used to prevent secondary complications in atherosclerotic cardiovascular disease, have been released.

A research team led by Professors Hong Myung-ki, Kim Byung-geuk, Hong Sung-jin, and Lee Yong-jun from the Department of Cardiology at Yonsei University Severance Hospital revealed that in patients with atherosclerotic cardiovascular disease, long-term follow-up results of rosuvastatin and atorvastatin treatment showed that rosuvastatin had a greater effect on lowering low-density lipoprotein (LDL) cholesterol, while atorvastatin was associated with fewer side effects such as diabetes and cataract surgery.

For patients with cardiovascular disease, it is important to maintain LDL cholesterol levels lower to prevent recurrence of myocardial infarction, stroke, and cardiac death. Statin drug therapy, which inhibits LDL cholesterol synthesis in the liver, is used to lower LDL cholesterol. Among these, rosuvastatin and atorvastatin, classified as high-potency statins in terms of LDL cholesterol reduction effect, are mainly used.

In addition to LDL cholesterol reduction, sufficient consideration of drug-related safety is necessary for long-term administration of statins. Statin-related side effects such as muscle symptoms and elevated liver enzyme levels occur more frequently with high-potency statins compared to low-potency statins. However, differences in these side effects depending on the type of statin have not been clarified.

The research team conducted the LODESTAR study from September 2016 to November 2019 at 12 hospitals in Korea, involving a total of 4,400 patients with cardiovascular diseases such as stable angina and acute coronary syndrome, performing two rounds of 1:1 random assignments.

In the first phase, patients were randomly assigned to either a statin intensity adjustment group targeting LDL cholesterol treatment goals (50?70 mg/dL) or a high-intensity statin maintenance group for analysis. In this study, a second random assignment was conducted with a 1:1 randomization between the high-potency statins rosuvastatin and atorvastatin to analyze clinical effects and side effects.

There were differences between rosuvastatin and atorvastatin in LDL cholesterol reduction efficacy and the occurrence of statin-related side effects such as diabetes and cataract surgery. During the follow-up period, LDL cholesterol levels were significantly lower in the rosuvastatin group at 68 mg/dL compared to 71 mg/dL in the atorvastatin group.

On the other hand, the incidence of statin-related side effects was lower in the atorvastatin group, with diabetes occurring in 5.3% compared to 7.2% in the rosuvastatin group, and cataract surgery incidence was also lower at 1.5% versus 2.5% in the rosuvastatin group.

Professor Hong Myung-ki stated, "Although rosuvastatin and atorvastatin are core treatments in cholesterol-lowering therapy for atherosclerotic cardiovascular disease, there has been no large-scale study directly comparing their long-term efficacy and safety in a large patient population until now. Based on the results of this study, it will be possible to select the appropriate type of statin according to the individual medical characteristics of each patient and provide tailored treatment."

This content was produced with the assistance of AI translation services.