Rosuvastatin not superior to Atorvastatin among patients with coronary artery disease: LODESTAR TRIAL

Coronary artery disease is a global threat making cardiac deaths a major concern. The major blood vessels i.e coronary arteries are incapable of sending enough blood, oxygen and nutrients to the heart muscle.

The LODESTAR trial was conducted to check the efficacy of Rosuvastatin and Atorvastatin over each other. The trial failed to show that rosuvastatin is superior to atorvastatin among patients with coronary artery disease. Rosuvastatin was associated with an excess incidence of initiation of diabetic medications and cataract operations. Based on this study, high-intensity atorvastatin therapy may be preferential to rosuvastatin. The trial is published in American College of Cardiology journal.

The researchers particularly aimed to evaluate rosuvastatin compared with atorvastatin among patients with coronary artery disease. A total of 4400 patients were included in the study. The study was designed to be a open labeled randomized parallel study. 2,204 of patients with coronary artery disease were randomized to rosuvastatin. A duration of 3 years of follow-up was kept. The mean age of patients was 65 years with 27% of them being females, and 33% had history of diabetes. The researchers included patients at least 19 years of age with coronary artery disease

Patients with pregnancy, Intolerance to statin or use of a medication that interacts with statin metabolism, risk for myopathy, limited life expectancy and low-density lipoprotein cholesterol (LDL-C) at enrollment, i.e 86 mg/dL were excluded.

The key findings of the study are

• The primary outcome such as death, stroke, myocardial infarction, or revascularization at 3 years, was 8.7% in the rosuvastatin group vs. 8.2% in the atorvastatin group (p = 0.58).

• High-intensity statin therapy dosing was achieved in 70.9% of the rosuvastatin group vs. 74.0% of the atorvastatin group (p = 0.022)

• LDL-C level <70 mg/dL at 3 years: 62.5% of the rosuvastatin group vs. 55.2% of the atorvastatin group (p < 0.001).

• Death at 3 years: 2.6% in the rosuvastatin group vs. 2.3% in the atorvastatin group (p = 0.57).

• Myocardial infarction at 3 years: 1.5% in the rosuvastatin group vs. 1.2% in the atorvastatin group (p = 0.37).

• Initiation of diabetic medication: 7.2% in the rosuvastatin group vs. 5.3% in the atorvastatin group (p = 0.031).

• Cataract operation: 2.5% in the rosuvastatin group vs. 1.5% in the atorvastatin group (p = 0.022)

The researchers ended that among patients with coronary artery disease, rosuvastatin was not superior to atorvastatin at preventing adverse cardiac events within 3 years. This lack of benefit was despite a higher frequency of subjects achieving LDL-C level <70 mg/dL at 3 years in the rosuvastatin group versus the atorvastatin group.

Reference: Anthony A. Bavry, MD, MPH, FACC; Rosuvastatin vs. Atorvastatin Treatment in Patients With Coronary Artery Disease – LODESTAR, Aug 25, 2023, Americ. Col. Cardio. Doi: https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2023/08/23/19/37/lodestar.