Achievement of English National Service Framework lipid-lowering goals: pooled data from recent comparative treatment trials of statins at starting doses

Despite the importance of reducing cardiovascular disease (CVD) risk, detailed in guidelines in many countries, repeated surveys show poor physician performance in attaining guideline lipid targets, which is associated with reluctance by physicians to up-titrate statins from starting doses. Data from randomised, double-blind trials comparing common starting doses of atorvastatin, pravastatin, rosuvastatin and simvastatin for 12 weeks in hypercholesterolaemic patients were therefore analysed for achievement of lipid-lowering goals recommended by the England National Service Framework (NSF) for coronary heart disease (CHD). In three pooled trials, rosuvastatin 10 mg (n = 389) reduced low-density lipoprotein cholesterol (LDL-C) and total cholesterol more significantly than atorvastatin 10 mg (n = 393) (p < 0.001). NSF goals were achieved by 83% of rosuvastatin patients vs. 55% of atorvastatin patients (p < 0.001) at relevant starting doses. In two pooled trials, rosuvastatin 10 mg (n = 226) reduced LDL-C and total cholesterol more significantly than simvastatin 20 mg (n = 249) and pravastatin 20 mg (n = 252) (p < 0.001). NSF goals were achieved at starting doses by 83% of rosuvastatin patients vs. 51% of simvastatin patients and 19% of pravastatin patients (p < 0.001 vs. each comparator). This improved achievement of NSF lipid target, at starting doses, was also seen in high-risk patients (those eligible for secondary prevention or primary prevention because of a 10-year CVD risk of >30%) with 84% patients on rosuvastatin vs. 58% on atorvastatin and 75% of patients on rosuvastatin vs. 49% on simvaststin and 24% on pravastatin. In summary, there are considerable and clinically significant variations in the achievement of lipid goals between common starting doses of statins in hypercholesterolaemic patients.

Rosuvastatin demonstrates greater reduction of low-density lipoprotein cholesterol compared with pravastatin and simvastatin in hypercholesterolaemic patients: a randomized, double-blind study

BACKGROUND

Rosuvastatin (Crestor), a new, highly efficacious statin, has demonstrated dose-dependent low-density lipoprotein cholesterol (LDL-C) reductions of up to 65% in a dose-ranging programme with doses of 1 to 80 mg.

DESIGN

A randomized, double-blind multicentre trial compared rosuvastatin with commonly used starting doses of pravastatin and simvastatin to determine relative efficacy in LDL-C reduction and impact on other lipid parameters in primary hypercholesterolaemia.

METHODS AND RESULTS

A total of 502 patients (greater-than-or-equal 18 years; LDL-C greater-than-or-equal 4.14 mmol/l [160 mg/dl] and < 6.50 mmol/l [250 mg/dl] and triglycerides less-than-or-equal 4.52 mmol/l [400 mg/dl]) were randomized to 12 weeks of rosuvastatin 5 mg (n = 120) or 10 mg (n = 115), pravastatin 20 mg (n=]137) or simvastatin 20 mg (n = 130). Rosuvastatin 5 and 10 mg reduced LDL-C by 42 and 49%, respectively, compared with 28% for pravastatin (P < 0.001 versus both rosuvastatin doses) and 37% for simvastatin (P < 0.01 versus rosuvastatin 5 mg; P < 0.001 versus 10[?]mg). National Cholesterol Education Program Adult Treatment Panel II (NCEP ATP II) goals were achieved by 87% of rosuvastatin 10[?]mg patients, 71% of rosuvastatin 5[?]mg patients, 53% of pravastatin patients, and 64% of simvastatin patients; similar proportions of patients achieved NCEP ATP III goals. European Atherosclerosis Society (EAS) goals were achieved by 83, 63, 20 and 50% of patients, respectively. All study treatments were well tolerated.

CONCLUSIONS

Both doses of rosuvastatin were more effective than pravastatin and simvastatin in meeting NCEP ATP II and EAS LDL-C targets. Rosuvastatin 10 mg was more effective than pravastatin and simvastatin in meeting NCEP ATP III targets.