Abstract
A progressive accumulation of atherosclerotic lesions beginning early in life puts elderly persons at a greater absolute risk of cardiovascular disease and coronary events than other segments of the population. HMG-CoA reductase inhibitor (statin) therapy has been shown to be both efficacious and well tolerated in most elderly patients. Among the statins, rosuvastatin has advantages in treating older patients: at low starting doses it is very efficacious compared with other statins, and thus more likely to enable patients to reach their low-density lipoprotein-cholesterol goals without the need for titration or combination therapy. Lack of clinically significant interactions with most drugs metabolised by cytochrome P450 enzyme 3A4 may also make rosuvastatin safer for patients taking multiple medications. Furthermore, rosuvastatin has shown efficacy in treating patients with many of the co-morbidities common in the elderly, including renal impairment and diabetes mellitus. As yet, however, cardiovascular endpoint data for rosuvastatin are not available.
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References
Bonow RO, Smaha LA, Smith Jr SC, et al. World Heart Day 2002: the international burden of cardiovascular disease: responding to the emerging global epidemic. Circulation 2002; 106: 1602–5
Grundy SM, Cleeman JI, Rifkind BM, et al. Cholesterol lowering in the elderly population. Arch Intern Med 1999; 159: 1670–8
Kuller LH, Arnold AM, Psaty BM, et al. 10-Year follow-up of subclinical cardiovascular disease and risk of coronary heart disease in the Cardiovascular Health Study. Arch Intern Med 2006; 166: 71–8
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III): final report. Circulation 2002; 106: 3143–420
Butler J, Rodondi N, Zhu Y, et al. Metabolic syndrome and the risk of cardiovascular disease in older adults. J Am Coll Cardiol 2006; 47: 1595–602
De Backer G, Ambrosioni E, Borch-Johnsen K, et al. Executive summary: European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2003; 24: 1601–10
British Cardiac Society; British Hypertension Society; Diabetes UK; HEART UK; Primary Care Cardiovascular Society; Stroke Association. JBS 2: Joint British Societies’ guidelines on prevention of cardiovascular disease in clinical practice. Heart 2005; 91Suppl. 5: v1–52
Conroy RM, Pyörälä K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 24: 987–1003
Lewis SJ, Moye LA, Sacks FM, et al. Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range: results of the Cholesterol and Recurrent Events (CARE) trial. Ann Intern Med 1998; 129: 681–9
Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20 536 people with cerebrovascular disease or other high-risk conditions. Lancet 2004; 363: 757–67
Miettinen TA, Pyörälä K, Olsson AG, et al. Cholesterol-lowering therapy in women and elderly patients with myocardial infarction or angina pectoris: findings from the Scandinavian Simvastatin Survival Study (4S). Circulation 1997; 96: 4211–8
Ray KK, Bach RG, Cannon CP, et al. Benefits of achieving the NCEP optional LDL-C goal among elderly patients with ACS. Eur Heart J 2006; 27: 2310–6
Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360: 1623–30
Packard CJ, Ford I, Robertson M, et al. Plasma lipoproteins and apolipoproteins as predictors of cardiovascular risk and treatment benefit in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Circulation 2005; 112: 3058–65
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in moderately hyperc-holesterolemic hypertensive patients randomized to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002; 288: 2998–3007
Scandinavian Simvastatin Survival Study. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383–9
Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–7
Sacks FM, Pfeffer MA, Moyé LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001–9
The Long-term Intervention with Pravastatin in Ischaemic disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349–57
Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 1998; 279: 1615–22
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360: 7–22
Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504
Sever PS, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet 2001; 361: 1149–58
Olsson AG, Pears J, McKellar J, et al. Effect of rosuvastatin on low-density lipoprotein cholesterol in patients with hyperc-holesterolemia. Am J Cardiol 2001; 88: 504–8
Brown WV, Bays HE, Hassman DR, et al. Efficacy and safety of rosuvastatin compared with pravastatin and simvastatin in patients with hypercholesterolemia: a randomized, double-blind, 52-week trial. Am Heart J 2002; 144: 1036–43
Paoletti R, Fahmy M, Mahla G, et al. Rosuvastatin demonstrates a greater reduction of low-density lipoprotein cholesterol compared with pravastatin and simvastatin in hypercholesterolaemic patients: a randomized, double-blind study. J Cardiovasc Risk 2001; 8: 383–90
Martin PD, Dane AL, Nwose OM, et al. No effect of age or gender on the pharmacokinetics of rosuvastatin: a new HMGCoA reductase inhibitor. J Clin Pharmacol 2002; 42: 1116–21
Leiter LA, Rosenson RS, Stein E, et al. Efficacy and safety of rosuvastatin 40mg versus atorvastatin 80mg in high-risk patients with hypercholesterolemia: results of the POLARIS study. Atherosclerosis. Epub 2007 Jan 15
Jones PH, Davidson MH, Stein EA, et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR trial). Am J Cardiol 2003; 92: 152–60
Blasetto JW, Stein EA, Brown WV, et al. Efficacy of rosuvastatin compared with other statins at selected starting doses in hypercholesterolemic patients and in special population groups. Am J Cardiol 2003; 91 Suppl.: 3–10C
Bays HE, Deedwania PC, Jones PH, et al. Comparative effects of statins on low-density lipoprotein cholesterol and high-density lipoprotein cholesterol in patients ≥65 years of age [abstract no. P319]. J Am Geriatr Soc 2004; 52 (4 Suppl.): S126
Sutton-Tyrell K, Lassila HC, Meilahn E, et al. Carotid atherosclerosis in premenopausal and postmenopausal women and its association with risk factors measured after menopause. Stroke 1998; 29: 1116–21
Shepherd J, Packard C, Littlejohn TW, et al. Lipid-modifying effects of rosuvastatin in postmenopausal women with hypercholesterolemia who are receiving hormone replacement therapy. Curr Med Res Opin 2004; 10: 1571–8
American Heart Association. Heart disease and stroke statistics: 2006 update. Dallas (TX): American Heart Association, 2006
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288: 321–33
Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003; 349: 523–34
Herrington DM, Reboussin DM, Brosnihan KB, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med 2000; 343: 522–9
Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998; 280: 605–13
Evans M, Rees A. Effects of HMG-CoA reductase inhibitors on skeletal muscle: are all statins the same? Drug Saf 2002; 25: 649–63
Schuster H. Improving lipid management: to titrate, combine or switch. Int J Clin Pract 2004; 58: 689–94
Crestor (rosuvastatin calcium) prescribing information. Wilmington (DE): AstraZeneca Pharmaceuticals LP, 2005 Jan
Schuster H, Barter PJ, Stender S, et al. Effects of switching statins on achievement of lipid goals: Measuring Effective Reductions in Cholesterol Using Rosuvastatin Therapy (MERCURY I) study. Am Heart J 2004; 147: 705–12
Ridker PM. Rosuvastatin in the primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: rationale and design of the JUPITER trial. Circulation 2003; 108: 2292–7
Epstein M. Aging and the kidney. J Am Soc Nephrol 1996; 7: 1106–22
National Kidney Foundation. K/DOQI 2002 clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39Suppl. 1: S1–266
Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32 (5 Suppl. 3): S112–9
Bianchi S, Bigazzi R, Caiazza A, et al. A controlled, prospective study of the effects of atorvastatin on proteinuria and progression of kidney disease. Am J Kidney Dis 2003; 41: 565–70
Keane WF, Mulcahy WS, Kasiske BL, et al. Hyperlipidemia and progressive renal disease. Kidney Int 1991; 39Suppl. 31: S41–8
Cheng JWM. Rosuvastatin in the management of hypercholesterolemia. Clin Ther 2004; 26: 1368–87
Vidt DG, Cressman MD, Harris S, et al. Rosuvastatin-induced arrest in progression of renal disease. Cardiology 2004; 102: 52–60
Fellström B, Zannad F, Schmieder R, et al. Effect of rosuvastatin on outcomes in chronic haemodialysis patients: design and rationale of the AURORA study. Curr Control Trials Cardiovasc Med 2005; 6(1): 9
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomized placebo-controlled trial. Lancet 2003; 361: 2005–16
Berne C, Siewert-Delle A. Comparison of rosuvastatin and atorvastatin for lipid lowering in patients with type 2 diabetes mellitus: results from the URANUS study. Cardiovasc Diabetol 2005 Jun 3; 4: 7
Tuomilehto J, Leifer LA, Kallend D. A review of the efficacy of rosuvastatin in patients with type 2 diabetes. Int J Clin Pract 2004; 58Suppl. 143: 30–40
Wolffenbuttel BHR, Franken AAM, Vincent HH. Cholesterol-lowering effects of rosuvastatin compared with atorvastatin in patients with type 2 diabetes: CORALL study. J Intern Med 2005; 257: 531–9
Purcell IF, Poole-Wilson PA. Heart failure: why and how to define it? Eur J Heart Fail 1999; 1: 7–10
Foody JM, Shah R, Galusha D, et al. Statins and mortality among elderly patients hospitalized with heart failure. Circulation 2006; 113: 1086–92
Horwich TB, MacLellan WR, Fonarow GC. Statin therapy is associated with improved survival in ischemic and non-ischemic heart failure. J Am Coll Cardiol 2004; 43: 642–8
Mozaffarian D, Nye R, Levy WC. Statin therapy is associated with lower mortality among patients with severe heart failure. Am J Cardiol 2004; 93: 1124–9
Khush KK, Waters DD, Bittner V, et al. Effect of high-dose atorvastatin on hospitalizations for heart failure: subgroup analysis of the Treating to New Targets (TNT) study. Circulation 2007; 115: 576–83
Krum H, Ashton E, Reid C, et al. Double-blind, randomized, placebo-controlled study of high-dose HMG CoA reductase inhibitor therapy on ventricular remodeling, pro-inflammatory cytokines and neurohormonal parameters in patients with chronic systolic heart failure. J Cardiac Fail 2007; 13: 1–7
Kjekshus J, Dunselman P, Blideskog M, et al. A statin in the treatment of heart failure? Controlled Rosuvastatin Multinational Study in Heart Failure (CORONA): study design and baseline characteristics. Eur J Heart Fail 2005; 7: 1059–69
Tavazzi L, Tognoni G, Franzosi MG, et al. Rationale and design of the GISSI heart failure trial: a large trial to assess the effects of n-3 polyunsaturated fatty acids and rosuvastatin in symptomatic congestive heart failure. Eur J Heart Fail 2004; 6: 635–41
Deedwania P, Stone PH, Bairey Merz CN, et al. Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE). Circulation 2007; 115: 700–7
Shepherd J, Vidt D, Miller E, et al. Safety of rosuvastatin: update on 16,876 rosuvastatin-treated patients in a multinational clinical trial program. Cardiology 2007; 107: 433–43
Brewer Jr HB. Benefit-risk assessment of rosuvastatin 10 to 40 milligrams. Am J Cardiol 2003; 92 Suppl.: 23–29K
Davidson MH. Rosuvastatin safety: lessons from the FDA review and post-approval surveillance. Expert Opin Drug Saf 2004; 3: 547–57
Omar MA, Wilson JP, Cox TS. Rhabdomyolysis and HMG-CoA reductase inhibitors. Ann Pharmacother 2001; 35: 1096–107
Sica DA, Gehr TW. Rhabdomyolysis and statin therapy: relevance to the elderly. Am J Geriatr Cardiol 2002; 11: 48–55
Pasternak RC, Smith Jr SC, Bairey-Merz CN, et al. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. Circulation 2002; 106: 1024–8
Bays H. Statin safety: an overview and assessment of the data: 2005. Am J Cardiol 2006; 97Suppl. 8A: 6–26C
Grundy SM. The issue of statin safety: where do we stand? Circulation 2005; 111: 3016–9
Rosenson RS. Current overview of statin-induced myopathy. Am J Med 2004; 116: 408–16
McTaggart F, Buckett L, Davidson R, et al. Preclinical and clinical pharmacology of rosuvastatin, a new 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor. Am J Cardiol 2001; 87Suppl. 5A: 28–32B
Sidaway JE, Davidson RG, McTaggart F, et al. Inhibitors of 3-hydroxy-3-methylglutaryl-CoA reductase reduce receptor-mediated endocytosis in opossum kidney cells. J Am Soc Nephrol 2004; 15: 2258–65
Food and Drug Administration. FDA response to a citizen petition on Crestor (3/14/2005) [online]. Available from URL: http://www.fda.gov/cder/drug/infopage/rosuvastatin/crestor_CP.pdf [Accessed 2006 Dec 13]
Agarwal R. Statin induced proteinuria: renal injury or renopro-tection? J Am Soc Nephrol 2004; 15: 2502–3
Bottorff MB. Safety and statins: pharmacologic and clinical perspectives. Am J Manag Care 2004; 4Suppl. 2: S27–37
Tuomilehto J, Harris S, Cressman M, et al. Safety of rosuvastatin in patients with diabetes [abstract]. International Forum for the Evaluation of Cardiovascular Care; 2004 Jan 21–23; Monte Carlo
Pfizer Inc. Lipitor (atorvastatin calcium) prescribing information. New York: Pfizer Inc., 2004 Jul
Merck & Co. Zocor (simvastatin) prescribing information. Whitehouse Station (NJ): Merck & Co., 2004 Nov
Bellosta S, Paoletti R, Corsini A. Safety of statins: focus on clinical pharmacokinetics and drag interactions. Circulation 2004; 109Suppl. 1: III50–7
Corsini A. The safety of HMG-CoA reductase inhibitors in special populations at high cardiovascular risk. Cardiovasc Drugs Ther 2003; 17: 265–85
Chong P. Lack of therapeutic interchangeability of HMG-CoA reductase inhibitors. Ann Pharmacother 2002; 36: 1907–17
Cooper KJ, Martin PD, Dane AL, et al. The effect of erythromycin on the pharmacokinetics of rosuvastatin. Eur J Clin Pharmacol 2003; 59: 51–6
Cooper KJ, Martin PD, Dane AL, et al. The effect of fluconazole on the pharmacokinetics of rosuvastatin. Eur J Clin Pharmacol 2002; 58: 527–31
Cooper KJ, Martin PD, Dane AL, et al. Lack of effect of ketoconazole on the pharmacokinetics of rosuvastatin in healthy subjects. Br J Clin Pharmacol 2003; 55: 94–9
Cooper KJ, Martin PD, Dane AL, et al. Effect of itraconazole on the pharmacokinetics of rosuvastatin. Clin Pharmacol Ther 2003; 73: 322–9
Martin PD, Dane AL, Schneck DW, et al. An open-label, randomized, three-way crossover trial of the effects of coadministration of rosuvastatin and fenofibrate on the pharmacokinetic properties of rosuvastatin and fenofibric acid in healthy male volunteers. Clin Ther 2003; 25: 459–71
Martin PD, Kemp J, Dane AL, et al. No effect of rosuvastatin on the pharmacokinetics of digoxin in healthy volunteers. J Clin Pharmacol 2002; 42: 1352–7
Ko DT, Mamdani M, Alter DA. Lipid-lowering therapy with statins in high-risk elderly patients: the treatment-risk paradox. JAMA 2004; 291: 1864–70
Robinson JG, Bakris G, Torner J, et al. Is it time for a cardiovascular primary prevention trial in the elderly? Stroke 2007; 38: 441–50
Acknowledgements
This work was supported by an unrestricted grant from AstraZeneca Pharmaceuticals. The author wishes to thank Ruth Sussman of Landmark Programs for editorial support in the preparation of this article. The author has received grant/research support and honoraria from, served as a consultant for, and been on the speakers’ bureau for Abbott, AstraZeneca, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, Roche, Sankyo, sanofi-aventis, Sumitomo and Takeda.
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Davidson, M.H. Rosuvastatin in Elderly Patients. Drugs Aging 24, 933–944 (2007). https://doi.org/10.2165/00002512-200724110-00005
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DOI: https://doi.org/10.2165/00002512-200724110-00005