Rosuvastatin, atorvastatin compared on effectiveness, safety in industry-funded trial

Analysis of a randomized trial in South Korea found that patients randomized to rosuvastatin developed type 2 diabetes requiring medication at a rate of 7.2%, compared to 5.3% among those given atorvastatin.

Rosuvastatin and atorvastatin were equally effective at preventing heart attacks, strokes, and death, but rosuvastatin was associated with a higher risk of developing type 2 diabetes than atorvastatin, an industry-funded study found.

Researchers analyzed the results of the LODESTAR clinical trial, involving 4,400 adults (average age, 65 years; 28% women) with coronary artery disease at 12 hospitals in South Korea. Patients were randomized to receive either daily rosuvastatin or atorvastatin for three years from September 2016 to November 2019. Researchers then examined differences between the two groups by deaths from any cause and rates of heart attacks, strokes, and coronary revascularization. Safety outcomes, including development of type 2 diabetes, hospital admissions due to heart failure, major blood clots, and cataract surgery, were also assessed. Funding was provided by Sam Jin Pharmaceutical and Chong Kun Dang Pharmaceutical. Results were published Oct. 18 by The BMJ.

In all, 4,341 of the 4,400 participants (98.7%) completed the trial. The researchers found no discernible differences between the two groups on the outcomes of all-cause death (2.6% in the rosuvastatin group compared to 2.3% in the atorvastatin group), heart attack (1.5% vs. 1.2%), stroke (1.1% vs. 0.9%) or revascularization (5.3% vs. 5.2%).

Average LDL cholesterol was lower in the rosuvastatin group than atorvastatin group (1.8 vs. 1.9 mmol/L). The rosuvastatin group had a higher rate of developing type 2 diabetes requiring medication (7.2% vs. 5.3%) and cataract surgery (2.5% vs. 1.5%) Other safety outcomes did not differ between the two groups.

The study authors highlighted the limitations that all the participants were of Asian ethnicity, limiting generalizability, and that the three-year study period may not be long enough to detect longer term effects of the two statins.

“Although reducing LDL cholesterol levels and the risk for future adverse cardiovascular events is the primary aim of statin treatment in people with coronary artery disease, safety is also a major concern for long term statin treatment,” they wrote. “Rosuvastatin was associated with lower LDL cholesterol levels, but it incurred a higher risk of new onset diabetes mellitus requiring antidiabetics and cataract surgery than atorvastatin.”