Comparison of the efficacy of rosuvastatin versus atorvastatin, simvastatin, and pravastatin in achieving lipid goals: results from the STELLAR trial.
Level 2 - randomized trial
Individual randomized controlled trial
PubMed 14687438 · doi:10.1185/030079903125002405
What was done
In the multicenter, parallel-group, open-label STELLAR trial, adults with hypercholesterolemia were randomized to 6 weeks of treatment with 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). This analysis assessed the proportion of patients achieving LDL-C and secondary lipid targets defined by NCEP ATP III, Joint European Societies, and Canadian guidelines.
What was found
At doses of 10 to 40 mg, 53% (83/156) to 80% (125/157) of patients taking rosuvastatin achieved LDL-C < 100 mg/dl (< 2.6 mmol/l), compared with 18% (28/158) to 70% (115/165) for atorvastatin, 8% (13/165) to 53% (86/163) for simvastatin, and 1% (1/160) to 8% (13/161) for pravastatin. For high-risk coronary heart disease patients, rosuvastatin 10–40 mg achieved guideline-defined LDL-C goals in 55%–77% (ATP III < 100 mg/dl, vs. 0%–64% for comparators), 76%–94% (European < 3.0 mmol/l, vs. 6%–81%), and 47%–69% (Canadian < 2.5 mmol/l, vs. 0%–53%). In patients with triglycerides ≥ 200 mg/dl, 80%–84% on rosuvastatin achieved both ATP III LDL-C and non-HDL-C goals versus 15%–84% on comparators.
Why it matters
Milligram for milligram, rosuvastatin was more efficacious than atorvastatin, simvastatin, and pravastatin in bringing hypercholesterolemic patients to guideline-recommended lipid targets.
Limits
The trial was open-label, lasted only 6 weeks, and evaluated surrogate lipid thresholds rather than hard cardiovascular outcomes or mortality. Total sample size and detailed adverse event rates were not reported in the abstract.
Cited by
- supports A 20 mg dose of atorvastatin is roughly equivalent in potency to a 10 mg dose of rosuvastatin.