Abstract
A high-intensity statin is recommended for the secondary prevention of cardiovascular diseases (CVD). However, real-world evidence of the effectiveness of rosuvastatin following acute coronary syndrome (ACS) is scarce. This retrospective cohort study included patients diagnosed with ACS to compare between the 2 high-intensity statin therapies (rosuvastatin vs atorvastatin) in terms of a primary composite outcome of CVD-associated death, non-fatal ACS, and non-fatal stroke at 1 month and 12 months post discharge. The primary effectiveness outcome did not differ between the 2 groups at 1 month (1.3% vs 1%; aHR = 1.64, 95% CI 0.55-4.94, P= 0.379) and at 12 months (4.8% vs 3.5%; aHR = 1.48, 95% CI 0.82-2.67, P= 0.199). Similarly, the 2 groups had comparable safety outcomes. In conclusion, the use of high-intensity rosuvastatin compared to high-intensity atorvastatin therapy in patients with ACS had resulted in comparable cardiovascular effectiveness and safety outcomes.
Highlights
A high-intensity statin is recommended for the secondary prevention of cardiovascular diseases (CVD)
The guidelines recommendations are based on landmark trials and a large meta-analysis of the statin landmark trials, such as Intensive vs Moderate Lipid Lowering with Statins after Acute Coronary Syndromes (PROVE IT) trial, Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease (TNT) trial, Incremental Decrease through Aggressive Lipid Lowering (IDEAL) trial, and a few other randomized controlled trials, which showed that the use of high-intensity statin therapy, mainly atorvastatin, reduced the incidence of many important clinical outcomes, including acute coronary syndrome (ACS), revascularization, and ischemic stroke compared to moderate or low intensity statin therapy.4À7
During the study period (1 January 2017 to 31 December 2018), we identified through the electronic pharmacy record system a total of 14,488 patients who were newly prescribed or prescribed refill prescriptions of a high-intensity statin either rosuvastatin 20 mg or 40 mg (n = 7116) or atorvastatin 40 mg or 80 mg (n = 7372)
Summary
A high-intensity statin is recommended for the secondary prevention of cardiovascular diseases (CVD). Real-world evidence of the effectiveness of rosuvastatin following acute coronary syndrome (ACS) is scarce This retrospective cohort study included patients diagnosed with ACS to compare between the 2 highintensity statin therapies (rosuvastatin vs atorvastatin) in Conflict of interest: The authors declare that they have no conflict of interest. The use of highintensity rosuvastatin compared to high-intensity atorvastatin therapy in patients with ACS had resulted in comparable cardiovascular effectiveness and safety outcomes. To the best of our knowledge, a few clinical studies evaluated the LDLC lowering effects of the 2 high-intensity statins (atorvastatin vs rosuvastatin), without assessing CV-related outcomes for secondary prevention. The effectiveness and safety of rosuvastatin following ACS has not been widely studied, especially in real-world context
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