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

Sep 05, 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:
08/25/2023
Date Updated:
09/05/2023
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:

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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