Rosuvastatin vs. Atorvastatin Treatment in Patients With Coronary Artery Disease - LODESTAR

Nov 03, 2023
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Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Trial Sponsor:
Yonsei University, Seoul, Korea
Date Presented:
08/25/2023
Date Published:
10/18/2023
Date Updated:
11/03/2023
Original Posted Date:
08/25/2023
References

Contribution To Literature:

The LODESTAR trial failed to show that rosuvastatin is superior to atorvastatin among patients with coronary artery disease.

Description:

The goal of the trial was to evaluate rosuvastatin compared with atorvastatin among patients with coronary artery disease.

Study Design

  • Randomization
  • Parallel
  • Open label

Patients with coronary artery disease were randomized to rosuvastatin (n = 2,204) vs. atorvastatin (n = 2,196).

  • Total number of enrollees: 4,400
  • Duration of follow-up: 3 years
  • Mean patient age: 65 years
  • Percentage female: 27%
  • Percentage with diabetes: 33%

Inclusion criteria:

  • Patients at least 19 years of age with coronary artery disease

Exclusion criteria:

  • Pregnancy
  • Intolerance to statin or use of a medication that interacts with statin metabolism
  • Risk for myopathy
  • Limited life expectancy

Other salient features/characteristics:

  • Low-density lipoprotein cholesterol (LDL-C) at enrollment, 86 mg/dL
  • Low-intensity statin therapy before randomization, 2%
  • Moderate-intensity statin therapy before randomization, 58%
  • High-intensity statin therapy before randomization, 24%

Principal Findings:

The primary outcome, death, stroke, myocardial infarction, or revascularization at 3 years, was 8.7% in the rosuvastatin group vs. 8.2% in the atorvastatin group (p = 0.58).

Secondary outcomes:

  • High-intensity statin therapy dosing was achieved in 70.9% of the rosuvastatin group vs. 74.0% of the atorvastatin group (p = 0.022)
  • LDL-C level <70 mg/dL at 3 years: 62.5% of the rosuvastatin group vs. 55.2% of the atorvastatin group (p < 0.001)
  • Death at 3 years: 2.6% in the rosuvastatin group vs. 2.3% in the atorvastatin group (p = 0.57)
  • Myocardial infarction at 3 years: 1.5% in the rosuvastatin group vs. 1.2% in the atorvastatin group (p = 0.37)
  • Initiation of diabetic medication: 7.2% in the rosuvastatin group vs. 5.3% in the atorvastatin group (p = 0.031)
  • Cataract operation: 2.5% in the rosuvastatin group vs. 1.5% in the atorvastatin group (p = 0.022)

Interpretation:

Among patients with coronary artery disease, rosuvastatin was not superior to atorvastatin at preventing adverse cardiac events within 3 years. This lack of benefit was despite a higher frequency of subjects achieving LDL-C level <70 mg/dL at 3 years in the rosuvastatin group versus the atorvastatin group. Rosuvastatin was associated with an excess incidence of initiation of diabetic medications and cataract operations. Based on this study, high-intensity atorvastatin therapy may be preferential to rosuvastatin.

References:

Highlighted text has been updated as of November 3, 2023.

Lee YJ, Hong SJ, Kang WC, et al., on behalf of the LODESTAR Investigators. Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomized LODESTAR trial. BMJ 2023;383:e075837.

Presented by Dr. Myeong-Ki Hong at the European Society of Cardiology Congress, Amsterdam, Netherlands, August 25, 2023.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Interventions and Coronary Artery Disease

Keywords: Acute Coronary Syndrome, Atorvastatin, Cholesterol, LDL, Coronary Artery Disease, Diabetes Mellitus, ESC23, ESC Congress, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Myocardial Revascularization, Rosuvastatin Calcium, Secondary Prevention, Stroke


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