A new study has found that Rosuvastatin and atorvastatin are both equally effective at lowering the risk of strokes, heart attacks, and mortality in patients with coronary heart disease. While the two drugs are similarly effective, they do possess a couple of key differences.
Taking Rosuvastatin can result in a more marked decrease in cholesterol levels, but it is associated with an elevated chance of developing diabetes and cataracts.
Many people with coronary heart disease may benefit from taking Rosuvastatin, as it can help to reduce their levels of low-density lipoprotein (LDL) cholesterol, which is considered to be the "bad" type of cholesterol.
Individuals who are prone to developing diabetes may be better off taking atorvastatin instead of other medications.
Researchers looked at 4,400 individuals who were involved in a clinical trial at 12 medical centres in South Korea. Participants were split into two groups and given Rosuvastatin or atorvastatin between September 2016 and November 2019. When the trial was finished, 4,341 individuals remained in the study.
The mean age of participants was 65, with a standard deviation of 10 years, and 27.9% were women.
Researchers were interested in analysing the effects of two different statins on the primary outcomes of heart attack, stroke, all-cause death, and the need for coronary revascularization. This procedure helps restore blood flow to a particular area of the heart. The results showed that the statins had similar effects on all these outcomes.
In the rosuvastatin group, 1.5% experienced heart attacks and 2.6% experienced all-cause deaths. Similarly, the atorvastatin group had 1.2% of heart attacks and 2.3% of all-cause deaths. Moreover, 1.1% and 0.9% of the groups, respectively, experienced strokes, and 5.3% and 5.2% of the groups needed coronary revascularization.
The authors conducted the study to assess safety, tracking any incidences of diabetes, heart failure leading to hospital admission, pulmonary thromboembolism or vein thrombosis, endovascular revascularisation due to peripheral artery disease, surgical aortic intervention, end-stage kidney disease, any discontinuation of either drug due to intolerance, cataract surgeries, and any combination of abnormal lab values.
People taking Rosuvastatin had a higher rate of type 2 diabetes, at 7.2%, compared to those taking atorvastatin, which was 5.3%. Additionally, the rosuvastatin group had a higher rate of requiring cataract surgery, 2.5%, than the atorvastatin group, which was 1.5%.
The study's senior investigator noted that although there were slight variations between the two statins concerning diabetes and cataracts, these differences were statistically significant.
A cardiologist who was not involved in the study mentioned that when considering a patient's medical profile and risk reduction strategies, these differences between the statins might play a role.
The study's findings regarding an increase in diabetes with one statin and an increase in cataract surgeries were not entirely unexpected, as earlier research had observed similar trends.
On a positive note, the group taking one of the statins had lower LDL cholesterol levels than the other group.
It's important to interpret these study findings carefully. The research does not endorse one specific type of statin over the other. Instead, it highlights that each statin has distinct strengths and weaknesses in lowering LDL cholesterol, potentially causing new-onset diabetes, and affecting cataracts.
Statins, originally derived from fungi, are commonly prescribed to lower cholesterol levels and reduce the risk of coronary heart disease.
In comparison to North America, which had the highest utilisation of statins in 2020 at 279.7 DDDs/TPD, Europe was not far behind with 159.9 DDDs/TPD. Latin America, MENA, East Asia, South Asia and sub-Saharan Africa had much lower utilisation rates of 66.1, 64.1, 29.3, 16.1 and 24.7 DDD/TPD, respectively.
Statins work by reducing the accumulation of atherosclerotic plaques in coronary arteries, decreasing the risk of heart attacks by preventing blockages in critical arteries that supply oxygen to the heart.
Although the exact mechanism of how statins maintain artery health is not fully understood, a 2023 study may provide answers. This research suggests that statins prevent a protein called YAP from loosening tightly bundled DNA, known as chromatin, in the endothelial cells lining blood vessels. This prevents changes in gene expression that would otherwise cause these cells to transform into less flexible and functional mesenchymal cells.
Diabetes itself can bring about structural changes in the eye's lens, potentially leading to cataracts. This occurs due to prolonged exposure of the eyes to elevated blood glucose levels.
Diabetic retinopathy, a known complication of diabetes, can even lead to blindness. While cataracts are a common part of ageing, individuals with diabetes often experience accelerated development of cataracts at a younger age, resulting in the accumulation of deposits on the eye's lens.
Our study underscores the importance of careful monitoring and adopting appropriate lifestyle measures to reduce the risk of developing new-onset diabetes or cataracts in individuals with coronary artery disease when considering Rosuvastatin instead of atorvastatin.
There are several limitations in the study worth considering. Firstly, it focused solely on East Asian individuals from Korea, lacking representation from other racial groups. Additionally, the study's participant demographics, particularly the ages of female participants, remain unclear.
It's important to note that high lipid levels are a recognised risk factor for heart disease, which is the leading cause of death among women globally. Dyslipidemia tends to increase as women age, with significant changes occurring during menopause, often linked to decreased estrogen levels that impact lipid profiles.
Furthermore, the study did not track osteoporosis in menopausal women. Cholesterol-lowering medications, including statins, may have varying effects on the risk of osteoporosis in menopausal women, depending on the dosage used.
For expert consultations and guidance on various health concerns, including those related to cholesterol management and medication, you can consult with Mobi Doctor. Their healthcare professionals are available to provide personalised advice and support.