Efficacy measures were similar in adults with coronary artery disease when treated with rosuvastatin or atorvastatin, but a secondary analysis of the LODESTAR trial showed more safety concerns with rosuvastatin. “Rosuvastatin and atorvastatin showed comparable efficacy for the composite outcome of all cause death, myocardial infarction, stroke, or any coronary revascularisation at three years,” the authors conclude. “Rosuvastatin was associated with lower LDL cholesterol levels but a higher risk of new onset diabetes mellitus requiring antidiabetics and cataract surgery compared with atorvastatin.”
Conducted at 12 South Korean hospitals, the trial included 4,400 adults aged 19 years or older with coronary artery disease. “4,341 of the 4,400 participants (98.7%) completed the trial,” the study report. “Mean daily dose of study drugs was 17.1 mg (standard deviation (SD) 5.2 mg) in the rosuvastatin group and 36.0 (12.8) mg in the atorvastatin group at three years (P <0.001). The primary outcome occurred in 189 participants (8.7%) in the rosuvastatin group and 178 (8.2%) in the atorvastatin group (hazard ratio 1.06, 95% confidence interval 0.86 to 1.30; P = 0.58). The mean low density lipoprotein (LDL) cholesterol level during treatment was 1.8 mmol/L (SD 0.5 mmol/L) in the rosuvastatin group and 1.9 (0.5) mmol/L in the atorvastatin group (P <0.001). The rosuvastatin group had a higher incidence of new onset diabetes mellitus requiring initiation of antidiabetics (7.2% v 5.3%; hazard ratio 1.39, 95% confidence interval 1.03 to 1.87; P = 0.03) and cataract surgery (2.5% v 1.5%; 1.66, 1.07 to 2.58; P = 0.02). Other safety endpoints did not differ between the two groups.”