Effects of Rosuvastatin Versus Atorvastatin, Alone or in Combination, on Lipoprotein (a)

Vavlukis, Marija and Mladenovska, Kristina and Daka, Arlinda and Dimovski, Aleksandar and Domazetovska, Saska and Kuzmanovska, Sonja and Kedev, Sasko (2016) Effects of Rosuvastatin Versus Atorvastatin, Alone or in Combination, on Lipoprotein (a). Annals of Pharmacotherapy, 50 (8). pp. 609-615. ISSN 1060-0280

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Background: Elevated lipoprotein (a) [Lp(a)] is an independent risk factor for coronary artery disease (CAD). However, there is little evidence about the therapeutic efficacy of different lipid-lowering agents in reducing Lp(a). Objective: The primary objective of our study was to test the effect of different therapeutic treatment strategies on elevated Lp(a) levels, specifically to compare rosuvastatin versus atorvastatin alone or in combination with niacin or fibrates. The secondary objective was to analyze the occurrence of potential adverse effects. Methods: It was a prospective, single-center, interventional study. Patients with CAD, or high CAD risk, with increased Lp(a), >50 mg/dL, were included in the study. Lp(a), total cholesterol (C), triglycerides (TGs), high-density lipoprotein cholesterol and low-density lipoprotein cholesterol (LDL-C), apolipoprotein (Apo) A1, Apo B, and enzymes of myocyte and hepatic injury were comparatively analyzed between 4 lipid-lowering treatment strategies: rosuvastatin (R group) 40 mg, atorvastatin (A group) 80 mg, atorvastatin 40 mg add-on micronized fenofibrate (A+F group), and atorvastatin 40 mg add-on 1 g extended-release niacin (A+ERN group). Comparison was made for their lipid lowering therapeutic efficacy, primarily on Lp(a), and their safety profile. Results: A total of 87 patients, 61 ± 12 years old, were analyzed. The main risk factors were obesity (64.7%) and hypertension (64.6%). Men were more often smokers (odds ratio [OR] = 5.1) and had CAD (OR = 2.8), but lower total C (206.9 ± 32.9 vs 238.6 ± 47.9 mg/dL, P = 0.002) and LDL-C (136.5 ± 18.2 vs 160.9 ± 30.9 mg/dL, P = 0.000). Mean Lp(a) was 94.6 ± 39.6 mg/dL, without significant gender difference. There were 25 patients in the R group, 22 in the A group, and 20 each in the A+F and A+ERN groups. Significant reduction in all lipid fractions in all treatment groups was reported after 6 months. The average reduction of Lp(a) was 15.9 ± 21.0 mg/dL, with 18.2 ± 24.8 (P = 0.001) in the R group and similar values in the A+F and A+ERN groups (17.3 ± 10.4, P = 0.001, and 19.5 ± 10.9, P = 0.001, respectively), and the lowest in the A group (11.24 ± 22.91, P = 0.032). No adverse effects were observed in any of the treatment groups. Conclusions: When compared with atorvastatin, it seems that rosuvastatin can achieve a statistically more significant decrease of Lp(a). The efficacy of atorvastatin on the Lp(a) optimization can be increased by adding either fibrate or ERN. Given in recommended doses, all agents were well tolerated.

Item Type: Article
Subjects: Medical and Health Sciences > Clinical medicine
Divisions: Faculty of Medical Science
Depositing User: Marija Vavlukis
Date Deposited: 16 Dec 2016 10:52
Last Modified: 16 Dec 2016 10:52
URI: https://eprints.ugd.edu.mk/id/eprint/16771

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