20 Oct 2023 • 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 revascularisation 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 as per the results of a secondary analysis of the randomised LODESTAR trial, published this week in BMJ.

THE LODESTAR TRIAL

• Participants: 4400 adults (age ≥19 years) with coronary artery disease.
• Interventions: Participants were assigned to receive either rosuvastatin or atorvastatin using 2×2 factorial randomisation.
• Results:
• The mean low density lipoprotein cholesterol level during treatment was 1.8 mmol/L (SD 0.5 mmol/L) in the rosuvastatin group and 1.9 (0.5) mmol/L in the atorvastatin group.
• The rosuvastatin group had a higher incidence of new onset diabetes mellitus requiring initiation of antidiabetics (7.2% v 5.3%) and cataract surgery (2.5% v 1.5%). Other safety endpoints did not differ between the two groups.

Although reducing LDL cholesterol levels and the risk for future adverse cardiovascular events is the primary aim of statin treatment in people with coronary artery disease, safety is also a major concern for long term statin treatment. To determine whether the increase in new onset diabetes mellitus and cataract surgery is directly related to the statin treatment, the underpinning mechanism for these relations and the possible mechanism for a drug effect still require further investigations.

Source: BMJ | Read full story