Advertisement

Effects of rosuvastatin versus atorvastatin, simvastatin, and pravastatin on non-high-density lipoprotein cholesterol, apolipoproteins, and lipid ratios in patients with hypercholesterolemia: additional results from the STELLAR trial

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Background:

      Non-high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) B, and lipid and apolipoprotein ratios that include both atherogenic and antiatherogenic lipid components have been found to be strong predictors of coronary heart disease risk.

      Objective:

      The goal of this study was to examine prospectively the effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin across dose ranges on non-HDL-C, apo B, apo A-I, and total cholesterol (TC):HDL-C, low-density lipoprotein cholesterol (LDL-C):HDL-C, non-HDL-C:HDL-C, and apo B:apo A-I ratios in patients with hypercholesterolemia (LDL-C >-160 mg/dL and <250 mg/dL and triglycerides <400 mg/dL) in the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) trial.

      Methods:

      In this randomized, Multicenter, parallel-group, open-label trial (4522IL/0065), patients >-18 years of age received rosuvastatin 10, 20, 40, or 80 mg; atorvastatin 10, 20, 40, or 80 mg; simvastatin 10, 20, 40, or 80 mg; or pravastatin 10, 20, or 40 mg for 6 weeks. Pairwise comparisons were prospectively planned and performed between rosuvastatin 10, 20, and 40 mg and milligram-equivalent or higher doses of comparators.

      Results:

      A total of 2268 patients were randomized to the rosuvastatin 10- to 40-mg, atorvastatin, simvastatin, and pravastatin groups. Fifty-one percent of patients were women, the mean (SD) age was 57 (12) years, and 19% had a documented history of atherosclerotic disease. Over 6 weeks, rosuvastatin significantly reduced non-HDL-C, apo B, and all lipid and apolipoprotein ratios assessed, compared with milligram-equivalent doses of atorvastatin and milligram-equivalent or higher doses of simvastatin and pravastatin (all, P < 0.002). Rosuvastatin reduced non-HDL-C by 42.0% to 50.9% compared with 34.4% to 48.1% with atorvastatin, 26.0% to 41.8% with simvastatin, and 18.6% to 27.4% with pravastatin. Rosuvastatin reduced apo B by 36.7% to 45.3% compared with 29.4% to 42.9% with atorvastatin, 22.2% to 34.7% with simvastatin, and 14.7% to 23.0% with pravastatin. The highest increase in apo A-I (8.8%) was observed in the rosuvastatin 20-mg group, and this increase was significantly greater than in the atorvastatin 40-mg and 80-mg groups (both, P < 0.002).

      Conclusion:f

      Rosuvastatin 10 to 40 mg was more efficacious in improving the lipid profile of patients with hypercholesterolemia than milligram-equivalent doses of atorvastatin and milligram-equivalent or higher doses of simvastatin and pravastatin.
      To read this article in full you will need to make a payment
      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
        Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.
        Circulation. 2002; 106: 3143-3421
        • Bittner V.
        • Hardison R.
        • Kelsey S.F.
        • Bypass Angioplasty Revascularization Investigation
        • et al.
        Non-highdensity lipoprotein cholesterol levels predict five-year outcome in the Bypass Angioplasty Revascularization Investigation (BARI).
        Circulation. 2002; 106: 2537-2542
        • Frost P.H.
        • Davis B.R.
        • Burlando A.J.
        • et al.
        Serum lipids and incidence of coronary heart disease. Findings from the Systolic Hypertension in the Elderly Program (SHEP).
        Circulation. 1996; 94: 2381-2388
        • Lamarche B.
        • Moorjani S.
        • Lupien P.J.
        • et al.
        Apolipoprotein A-I and B levels and the risk of ischemic heart disease during a five-year follow-up of men in the Quebec cardiovascular study.
        Circulation. 1996; 94: 273-278
        • Gotto Jr, A.M.
        • Whitney E.
        • Stein E.A.
        • et al.
        Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS).
        Circulation. 2000; 101: 477-484
        • Walldius G.
        • Jungner I.
        • Holme I.
        • et al.
        High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): A prospective study.
        Lancet. 2001; 358: 2026-2033
        • Qureshi A.I.
        • Giles W.I.T.
        • Croft J.B.
        • et al.
        Apolipoproteins A-I and B and the likelihood of non-fatal stroke and myocardial infarction—data from The Third National Health and Nutrition Examination Survey.
        Med Sci Monit. 2002; 8: CR311-CR316
        • Kinosian B.
        • Glick H.
        • Garland G.
        Cholesterol and coronary heart disease: Predicting risks by levels and ratios.
        Ann Intern Med. 1994; 121: 641-647
        • Wang T.D.
        • Chen W.J.
        • Chien K.L.
        • et al.
        Efficacy of cholesterol levels and ratios in predicting future coronary heart disease in a Chinese population.
        Am J Cardiol. 2001; 88: 737-743
        • Criqui M.H.
        • Golomb B.A.
        Epidemiologic aspects of lipid abnormalities.
        Am J Med. 1998; 105: 48S-57S
        • Castelli W.P.
        Cholesterol and lipids in the risk of coronary artery disease—the Framingham Heart Study.
        Can J Cardiol. 1988; 4: 5A-10A
        • Buchwald H.
        • Boen J.R.
        • Nguyen P.A.
        • et al.
        Plasma lipids and cardiovascular risk: A POSCH report. Program on the Surgical Control of the Hyperlipidemias.
        Atherosclerosis. 2001; 154: 221-227
        • Manninen V.
        • Tenkanen L.
        • Koskinen P.
        • et al.
        Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study Implications for treatment.
        Circulation. 1992; 85: 37-45
        • Schneck D.W.
        • Knopp R.H.
        • Ballantyne C.M.
        • et al.
        Comparative effects of rosuvastatin and atorvastatin across their dose ranges in patients with hypercholes terolemia and without active arterial disease.
        Am J Cardiol. 2003; 91: 33-41
        • Blasetto J.W.
        • Stein E.A.
        • Brown W.V.
        • et al.
        Efficacy of rosuvastatin compared with other statins at selected starting doses in hypercholesterolemic patients and in special population groups.
        Am J Cardiol. 2003; 91: 3C-10C
        • Jones P.H.
        • Davidson M.H.
        • Stein E.A.
        • et al.
        • STELLAR Study Group
        Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial).
        Am J Cardiol. 2003; 92: 152-160
        • Olsson A.G.
        • Istad H.
        • Luurila O.
        • et al.
        • Rosuvastatin Investigators Group
        Effects of rosuvastatin and atorvastatin compared over 52 weeks of treatment in patients with hypercholesterolemia.
        Am Heart J. 2002; 144: 1044-1051
        • Brown W.V.
        • Bays H.E.
        • Hassman D.R.
        • et al.
        • Rosuvastatin Investigators Group
        Efficacy and safety of rosuvastatin compared with pravastatin and simvastatin in patients with hypercholesterolemia: A randomized, double-blind, 52-week trial.
        Am Heart J. 2002; 144: 1036-1043
        • Remmell P.S.
        • Gorder D.D.
        • Hall Y.
        • Tillotson J.L.
        Assessing dietary adherence in the Multiple Risk Factor Intervention Trial (MRFIT). I. Use of a dietary monitoring tool.
        J Am Diet Assoc. 1980; 76: 351-356
        • Myers G.L.
        • Cooper G.R.
        • Winn C.L.
        • Smith S.J.
        The Centers for Disease Control-National Heart, Lung, and Blood Institute Lipid Standardization Program. An approach to accurate and precise lipid measurements.
        Clin Lab Med. 1989; 9: 105-135
        • Steiner P.
        • Freidel J.
        • Bremner W.
        • et al.
        Standardization of micromethods for plasma cholesterol, triglyceride and HDL-cholesterol with the lipid clinics' methodology.
        J Clin Chem Clin Biochem. 1981; 19 (Abstract): 850-851
        • Warnick G.R.
        • Albers J.J.
        A comprehensive evaluation of the heparin-manganese precipitation procedure for estimating high density lipoprotein cholesterol.
        J Lipid Res. 1978; 19: 65-76
        • Albers J.J.
        • Marcovina S.M.
        • Kennedy H.
        International Federation of Clinical Chemistry standardization project for measurements of apolipoproteins A-I and B. II. Evaluation and selection of candidate reference materials.
        Clin Chem. 1992; 38: 658-662
        • Miller Jr, R.G.
        Simultaneous Statistical Inference.
        2nd ed. Springer-Verlag, New York, NY1981
        • Rader D.J.
        • Davidson M.H.
        • Caplan R.J.
        • Pears J.S.
        Lipid and apolipoprotein ratios: Association with coronary artery disease and effects of rosuvastatin compared with atorvastatin, pravastatin, and simvastatin.
        Am J Cardiol. 2003; 91: 20C-24C
        • Schuster H.
        • Barter P.J.
        • Stender S.
        • et al.
        Effects of switching statins on achievement of lipid goals: Measuring Effective Reductions in Cholesterol Using Rosuvastatin Therapy (MERCURY I) study.
        Am Heart J. 2004; 147: 705-712
        • McKenney J.M.
        • Jones P.H.
        • Adamczyk M.A.
        • et al.
        • STELLAR Study Group
        Comparison of the efficacy of rosuvastatin versus atorvastatin, simvastatin, and pravastatin in achieving lipid goals: Results from the STELLAR trial.
        Curr Med Res Opin. 2003; 19: 689-698
        • Ballantyne C.M.
        • Andrews T.C.
        • Hsia J.A.
        • et al.
        • ACCESS Study Group
        Atorvastatin Comparative Cholesterol Efficacy and Safety Study. Correlation of nonhigh-density lipoprotein cholesterol with apolipoprotein B: Effect of 5 hydroxymethylglutaryl coenzyme A reductase inhibitors on non-high-density lipoprotein cholesterol levels.
        Am J Cardiol. 2001; 88: 265-269
        • Sniderman A.D.
        • Furberg C.D.
        • Keech A.
        • et al.
        Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment.
        Lancet. 2003; 361: 777-780
        • Pedersen T.R.
        • Olsson A.G.
        • Faergeman O.
        • et al.
        Lipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival Study (4S).
        Circulation. 1998; 97: 1453-1460
        • Genest J.
        • Frohlich J.
        • Fodor G.
        • McPherson R.
        • Working Group on Hypercholesterolemia and Other Dyslipidemias
        Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: Summary of the 2003 update.
        CMAJ. 2003; 169 ([published correction appears in CMAJ. 2003;169:1149]): 921-924