Rosuvastatin similar in efficacy to atorvastatin but poses higher risk of diabetes and cataract surgery, LODESTAR secondary analysis.

Prior marketing of statins before they became generic likely led to a common belief among physicians that rosuvastatin is "better" than atorvastatin in coronary artery disease patients (CAD). However the recent results from randomized LODESTAR trial showed that rosuvastatin was not superior to atorvastatin at preventing adverse cardiac events within 3 years. A recently published secondary analysis of the same trial has shed light on some further interesting findings. It has now been shown that although rosuvastatin administration led to lower LDL cholesterol levels, it also was linked to greater risks of new onset diabetes and cataract surgery.

To compare the long term efficacy and safety of rosuvastatin with atorvastatin treatment in adults with CAD, participants were assigned to receive either rosuvastatin (n=2204) or atorvastatin (n=2196) using 2×2 factorial randomisation.

The primary outcome was a three year composite of all cause death, myocardial infarction, stroke, or any coronary revascularisation. Secondary outcomes were safety endpoints like new onset diabetes mellitus, cataract surgery, etc.

The important trial findings were:

1. At 3 years, mean daily dose was lower in the rosuvastatin group compared with those on atorvastatin. Also, fewer patients in the rosuvastatin group were also taking ezetimibe.

2. The primary combined outcome 3 years was no different between agents, occurring in 8.7% of the rosuvastatin cohort and 8.2% in the atorvastatin arm.

3. Mean LDL cholesterol was lower for rosuvastatin-treated patients compared with those on atorvastatin,

4. But more of the former patients reported both new-onset diabetes requiring antidiabetic drugs (7.2% vs 5.3%) and cataract surgery (2.5% vs 1.5%).

5. There were no differences between the study groups for all other safety endpoints.

6. A higher incidence of new-onset diabetes in those treated with rosuvastatin compared with atorvastatin (9.5% vs 7.7%)

“This secondary analysis of the trial which focused on statin type will be helpful not only for physicians to optimize their practice in dyslipidemia management but also for the general population in providing insight regarding regular check-ups for blood glucose, HbA1c, and cataracts [that] should be considered when they are taking high-potency statins,” noted author Myeong-Ki Hong.

Based on these results, a clinician may now chose the most appropriate statin according to clinical scenario. For example, if the patient surely requires more intensive lowering of LDL-cholesterol levels, the rosuvastatin may be preferred. On the other hand, if the patient’s LDL levels are well-managed, but they have impaired fasting glycemia, then atorvastatin may be preferred.”

Source: BMJ: doi: https://doi.org/10.1136/bmj-2023-075837