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Efficacy and safety of rosuvastatin vs. atorvastatin in lowering LDL cholesterol

A meta-analysis of trials with East Asian populations
  • L. Zhang
  • S. Zhang
  • Y. Yu
  • H. JiangEmail author
  • J. GeEmail author
Original articles
  • 133 Downloads

Abstract

Background

The VOYAGER meta-analysis reported on the low-density lipoprotein cholesterol (LDL-C)-lowering effect of commonly used statins in Caucasian subjects. As there is limited literature available on the efficacy of statins in Asian populations, the current meta-analysis compared the effects of rosuvastatin and atorvastatin on LDL-C levels in an East Asian population.

Methods

The MEDLINE, PubMed, Embase, Cochrane Library, and Web of Science databases were searched for randomized controlled trials comparing lipid-lowering effects of rosuvastatin and atorvastatin in an East Asian population. Data on the study design, participant characteristics, and outcomes were extracted. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences were calculated using the random-effects model.

Results

The meta-analysis comprised 16 randomized controlled trials with 5930 participants. Compared with atorvastatin, patients treated with rosuvastatin had a significant reduction in LDL-C: WMD = −7.15 mg/dl (95% confidence intervals [CI]: −10.71–−3.60) mg/dl, p < 0.0001. Meta-regression analyses revealed no significant association between the superior benefits of rosuvastatin and other variables including age, sex, baseline LDL-C level, and follow-up duration. Additionally, the rosuvastatin group of patients, who were treated with half the dose of atorvastatin, achieved a significantly greater reduction in LDL-C levels (WMD = −3.57; 95% CI: −5.40–−1.74 mg/dl, p < 0.001). Both rosuvastatin and atorvastatin were well tolerated, with similar incidences of adverse events.

Conclusion

Similar to the VOYAGER meta-analysis, which reported a greater efficacy of rosuvastatin in comparison with atorvastatin and simvastatin in Caucasian patients, we found that the efficacy of rosuvastatin was superior to atorvastatin in East Asian patients with hypercholesterolemia.

Keywords

Statins Low-density lipoprotein Eastern Asia Treatment efficacy Hypercholesterolemia 

Wirksamkeit und Sicherheit von Rosuvastatin vs. Atorvastatin zur Senkung des LDL-Cholesterins

Metaanalyse randomisierter kontrollierter Studien in ostasiatischen Populationen

Zusammenfassung

Hintergrund

In der VOYAGER-Metaanalyse wurde über den Effekt üblicherweise eingesetzter Statine auf die Senkung des Low-Density-Lipoprotein-Cholesterins (LDL-C) bei Kaukasiern berichtet. Da nur begrenzt Literatur zur Wirksamkeit von Statinen in asiatischen Populationen verfügbar ist, wurde in der aktuellen Metaanalyse die Wirkung von Rosuvastatin und Atorvastatin auf den LDL-C-Spiegel bei einer ostasiatischen Population verglichen.

Methoden

Die Datenbanken MEDLINE, PubMed, Embase, Cochrane Library und Web of Science wurden in Bezug auf randomisierte kontrollierte Studien durchsucht, in denen der lipidsenkende Effekt von Rosuvastatin und Atorvastatin in einer ostasiatischen Population verglichen wurde. Daten zu Studiendesign, Merkmalen der Teilnehmer und Ergebnissen wurden extrahiert. Odds Ratios (OR), gewichtete mittlere Differenzen („weighted mean differences“, WMD) oder standardisierte mittlere Differenzen wurden unter Verwendung des Random-Effects-Modells berechnet.

Ergebnisse

Die Metaanalyse umfasste 16 randomisierte kontrollierte Studien mit 5930 Teilnehmern. Im Vergleich zu Atorvastatin wiesen mit Rosuvastatin behandelte Patienten eine signifikante Senkung des LDL-C auf: WMD = −7,15 mg/dl (95%-Konfidenzintervall, 95%-KI: −10,71 bis −3,60 mg/dl; p < 0,0001). Metaregressionsanalysen ergaben keinen signifikanten Zusammenhang zwischen dem überlegenen Nutzen von Rosuvastatin und anderen Variablen einschließlich Alter, Geschlecht, Ausgangswert des LDL-C und Nachbeobachtungsdauer. Zusätzlich erzielte die Patientengruppe, die Rosuvastatin nur in der halben Dosierung erhielt, eine signifikant stärkere Senkung des LDL-C-Werts als die Gruppe mit der normalen Dosis Atorvastatin (WMD = −3,57; 95%-KI: −5,40 bis −1,74 mg/dl; p < 0,001). Sowohl Rosuvastatin als auch Atorvastatin wurden gut vertragen und zeigten eine ähnliche Inzidenz unerwünschter Ereignisse.

Schlussfolgerung

Ähnlich wie die VOYAGER-Metaanalyse, in der über eine höhere Wirksamkeit von Rosuvastatin im Vergleich zu Atorvastatin und Simvastatin bei Patienten kaukasischen Typs berichtet wurde, stellten die Autoren fest, dass die Wirksamkeit von Rosuvastatin der von Atorvastatin bei ostasiatischen Patienten mit Hypercholesterinämie überlegen war.

Schlüsselwörter

Statine Low-Density-Lipoprotein Ostasien Behandlungswirksamkeit Hypercholesterinämie 

Notes

Acknowledgements

We would like to thank Dr. Dhanya M and Mr. Karan Sharma from Indegene, Bangalore, for providing medical writing support and technical assistance in the preparation of this manuscript.

Funding

This study was funded by the National Key R&D Program of China (No. 2016YFC1301200) and the National Natural Science Foundation of China (No. 81400193, 81670355 and 81600294).

Compliance with ethical guidelines

Conflict of interest

L. Zhang, S. Zhang, Y. Yu, H. Jiang, and J. Ge declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

59_2018_4767_MOESM1_ESM.pdf (35 kb)
Supplementary Fig. 1. Funnel plot of included studies. MD mean difference
59_2018_4767_MOESM2_ESM.doc (95 kb)
Supplementary Table 1. Quality assessment of included studies
59_2018_4767_MOESM3_ESM.docx (14 kb)
Supplementary Table 2. Adverse events among the study population

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan HospitalShanghai Medical College of Fudan UniversityShanghaiChina
  2. 2.Department of General Practice, Zhongshan HospitalShanghai Medical College of Fudan UniversityShanghaiChina

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