Subject: Evaluation of Efficacy & Safety of Rosuvastatin in Indian Dyslipidemia patients
Rosuvastatin is a potent statin with pharmacologic and pharmacokinetic advantages over other statins. Its high affinity for OATP-1B1 ensure a high hepatocyte concentration which results in superior efficacy at lowering LDL-C and TG as well as improving HDL-C and ApoB:ApoA ratio compared to other statins. Rosuvastatin is synthetic with a relatively low lipophilicity when compared with other statins and has minimal entry into peripheral cells. This, coupled with its minimal CYP450 metabolism confers relatively better tolerability, safety and drug interaction profile. As the circulating half-life is 19 hrs it can be taken once daily at any time of the day regardless of meals.
Clinical trial data and post marketing surveillance have demonstrated important information about rosuvastatin. Several cardiovascular outcome studies have confirmed the beneficial effects that had been anticipated from vascular imaging studies. JUPITER showed the reduction in cardiovascular events and all-cause mortality of rosuvastatin in primary prevention in patients with lower cardiovascular risk. This is the only statin that has been shown to reduce cardiovascular and all-cause mortality. Comparative studies have shown the potential benefits of rosuvastatin in secondary prevention and high intensity therapy. Given its potency and safety, rosuvastatin is a versatile statin that can be used in different clinical contexts.
Patients with a 10-year cardiovascular risk of >20% require intensive treatment to achieve LDL-C >2 mmol/L or a >50% reduction from baseline. These include patients with established CHD, moderate to severe CKD, type 1 and type 2 diabetes. Only rosuvastatin 20 mg–40 mg and atorvastatin 80 mg achieve this reduction as monotherapy. A large proportion of these patients are on multiple drug therapy and thus it is crucial to limit pill burden and avoid drug interactions. Most lipid therapy is now aimed at achieving treatment goals from guideline bodies such as ESC, JBS and NCEP ATP III. A new category of patients is thus created by those who fail to achieve these goals with various treatments. Such patients should be considered for treatment with rosuvastatin.
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