MANILA, Philippines - Two recent studies have shown that the AstraZeneca anti-cholesterol drug rosuvastatin demonstrated ability to reduce the risk of cardiovascular disease and is better than simvastatin and atorvastatin in the overall management of hypercholesterolemia.
Simvastatin, atorvastatin and rosuvastatin are types of statins, a class of drug used for treating high cholesterol.
“One study showed that in apparently healthy people with normal LDL (“bad”) cholesterol levels but have elevated levels of an inflammatory biomarker that predicts cardiovascular events, rosuvastatin significantly reduced the incidence of major cardiovascular events.
The other study showed that rosuvastatin was not only better than the two other statins in lowering LDL but also in elevating HDL (“good”) cholesterol,” said Dr. Phillip Barter, professor of medicine at the University of Sydney and Director of the Heart Research Institute in the same institution.
Barter was the guest speaker during a recent dinner symposium organized by research-based biopharmaceutical company AstraZeneca at the Marriot Hotel in Pasay City.
He presented the results of two studies on rosuvastatin, JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating rosuvastatin) and VOYAGER (indiVidual patient data meta-analysis Of statin therapY in At-risk Groups: Effects of rosuvastatin, atorvastatin and simvastatin).
“AstraZeneca has been recently recognized as the pharmaceutical company with the best cardiovascular pipeline. We have over 40 years of experience in cardiology and we continue to invest in research and development on therapeutic areas with unmet medical needs. We hope that the findings of our landmark studies will help doctors provide better cardiovascular protection to at-risk patients,” said Amal Kelshikar, president of AstraZeneca Philippines.
C-reactive protein (CRP) is a protein whose levels in the blood rise during acute stages of inflammation, such as a heart attack. “Increased CRP levels predict cardiovascular events,” Barter said.
Landmark study
JUPITER, which involved almost 18,000 patients from 26 countries, showed that rosuvastatin reduced LDL cholesterol levels by 50 percent and high-sensitivity CRP (hsCRP) levels by 37 percent.
The landmark study was stopped earlier than planned after an independent panel of experts found unequivocal evidence of a reduction in cardiovascular disease (morbidity) and death (mortality) among patients who received rosuvastatin when compared to those receiving placebo.
“Previous studies have established that patients with low HDL cholesterol remain at significant risk for cardiac events (e.g. heart attack) even if their LDL cholesterol has already been lowered to target,” Barter said.
According to Barter, high levels of LDL contribute to atherosclerosis, the clogging of arteries caused by the accumulation of fatty deposits, usually cholesterol, called plaques. Atherosclerosis increases the risk for heart attack and stroke. On the other hand, high levels of HDL prevent atherosclerosis thereby lowering the risk for cardiovascular disease, he explained.
VOYAGER data
Barter and his colleagues analyzed data from VOYAGER, a database derived from 37 rosuvastatin studies involving 33,000 patients that examined rosuvastatin, atorvastatin, or simvastatin.
“While all three statins are very effective in lowering LDL, our analysis showed that on a milligram per milligram basis atorvastatin is more effective than simvastatin but rosuvastatin is superior to atorvastatin in lowering LDL,” Barter said.
The analysis also showed that patients on rosuvastatin increased their HDL levels by up to eight percent, Barter said.
Simvastatin showed relatively similar results but was not quite as effective as rosuvastatin. “Atorvastatin yielded the smallest elevation of HDL and, in a puzzling twist, HDL elevation diminished as the atorvastatin dose increased,” Barter said.
Barter noted that a lower dosage of statin is recommended to reduce the risk of side effects. “Rosuvastatin 20mg is proven safe and as effective as the highest doses (40-80 mg) of any of the other statins. Rosuvastatin 10mg is very effective in lowering LDL and raises HDL more than any dose of any of the other statins.”
The ideal HDL level is at least 40 mg/dl, according to Barter. Low HDL levels are usually caused by lifestyle factors, such as being sedentary and overweight and smoking.
“Genetic causes of low HDL are uncommon except in two countries: Turkey and the Philippines. About 80 percent of Filipinos have HDL levels below 40 mg/dl,” Barter said.
He warned that most cases of low HDL are associated with abdominal obesity. “For people genetically predisposed to low HDL such as Filipinos, becoming overweight is especially dangerous,” he said.
Lifestyle modification is very effective in increasing HDL, according to Barter. “Weight loss, regular physical activity and smoking cessation can increase HDL levels by up to 25 percent,” he said.
However for people in whom lifestyle modification is not enough or who are unable to modify their lifestyle, medicine may be prescribed to help raise their HDL levels, he added.