Posted on Oct 25, 2023, 3 p.m.
Article courtesy of Dr. Joel Kahn, MD, who is a Clinical Professor of Medicine at Wayne State University School of Medicine, one of the world's top cardiologists, a best-selling author, lecturer, and a leading expert in plant-based nutrition and holistic care.
For many patients with a high LDL-cholesterol and confirmed atherosclerosis (prior heart attack, stent, bypass surgery, carotid surgery, abdominal aneurysm high calcium score, abnormal coronary CT angiogram), lifestyle changes along with medications to lower the LDL-C are indicated. Statin medications are the most common prescription to lower LDL-C but they may differ in potency and side effects.
A recent study sought to compare the long-term efficacy and safety of the two most widely used statins, rosuvastatin with atorvastatin, in the treatment of adults with coronary artery disease.
The study was a randomized, open-label, multicenter trial performed in 12 hospitals in South Korea, from September 2016 to November 2019. There were 4400 adults (age ≥19 years) with coronary artery disease entered into the trial. Participants were assigned to receive either rosuvastatin (n=2204) or atorvastatin (n=2196) using 2×2 factorial randomization.
The primary outcome was a three-year composite of all cause death, myocardial infarction, stroke, or any coronary revascularization. Secondary outcomes were safety endpoints: new-onset diabetes mellitus; hospital admissions due to heart failure; deep vein thrombosis or pulmonary thromboembolism; endovascular revascularization for peripheral artery disease; aortic intervention or surgery; end-stage kidney disease; discontinuation of study drugs owing to intolerance; cataract surgery; and a composite of laboratory detected abnormalities.
A total of 4341 of the 4400 participants (98.7%) completed the trial.
The mean daily dose of study drugs was 17.1 mg in the rosuvastatin group and 36.0 mg in the atorvastatin group at three years.
The primary outcome occurred in 189 participants (8.7%) in the rosuvastatin group and 178 (8.2%) in the atorvastatin group.
The mean low-density lipoprotein (LDL) cholesterol level during treatment was 1.8 mmol/L in the rosuvastatin group and 1.9 mmol/L in the atorvastatin group.
The rosuvastatin group had a higher incidence of new-onset diabetes mellitus requiring initiation of antidiabetics and cataract surgery (2.5% v 1.5%). Other safety endpoints did not differ between the two groups.
In adults with coronary artery disease, rosuvastatin and atorvastatin showed comparable efficacy for the composite outcome of all cause death, myocardial infarction, stroke, or any coronary revascularization at three years.
Rosuvastatin was associated with lower LDL cholesterol levels but a higher risk of new-onset diabetes mellitus requiring antidiabetics and cataract surgery compared with atorvastatin.
The researchers acknowledge several study limitations including the fact that only Asian participants were included in this trial, and the three-year study period may have been relatively short to find longer-term effects of two statin types.
The impact of taking coQ10 with the statins on the risk of diabetes type 2 was not reported. At the Kahn Center, we always add CoQ10 to patients on statins, usually 400 mg a day.
About the author: At his core, Dr. Joel Kahn believes that plant-based nutrition is the most powerful source of preventative medicine on the planet. Having practiced traditional cardiology since 1983, it was only after his own commitment to a plant-based vegan diet that Dr. Kahn truly began to delve into the realm of non-traditional diagnostic tools, prevention tactics, and nutrition-based recovery protocols.
As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement.
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