Is Rosuvastatin (Crestor) more potent than Lovastatin?

From the Guidelines

Crestor (rosuvastatin) is generally considered stronger than lovastatin due to its greater LDL-cholesterol lowering ability at comparable doses. According to a study published in Circulation in 2004 1, rosuvastatin can reduce LDL cholesterol by approximately 39-45% at doses of 5-10 mg, whereas lovastatin typically reduces LDL by only 31% at a dose of 40 mg.

Key Points to Consider

• The difference in potency between rosuvastatin and lovastatin is due to their distinct chemical structures and interactions with the liver enzyme HMG-CoA reductase, which is responsible for cholesterol production.
• Rosuvastatin has a longer half-life (approximately 19 hours) compared to lovastatin's 2-3 hours, and is more hydrophilic, meaning it's less likely to cross into certain tissues like the brain.
• When switching between these medications, patients typically need a lower dose of Crestor to achieve the same cholesterol-lowering effect as a higher dose of lovastatin.
• The stronger potency of Crestor may also come with a slightly higher risk of side effects like muscle pain or liver enzyme elevations in some patients.

Comparison of Statins

• The study published in Circulation in 2004 1 provides a comparison of the doses of currently available statins required to attain an approximate 30-40% reduction of LDL-C levels, as shown in the table:

  Drug	Dose, mg/d	LDL Reduction, %
  Atorvastatin	10	39
  Lovastatin	40	31
  Pravastatin	40	34
  Simvastatin	20–40	35–41
  Fluvastatin	40–80	25–35
  Rosuvastatin	5–10	39–45
  This comparison highlights the greater potency of rosuvastatin compared to lovastatin.

From the FDA Drug Label

Rosuvastatin was compared with the statins (atorvastatin, simvastatin, and pravastatin) in a multicenter, open-label, dose-ranging study of 2,240 patients with hyperlipidemia or mixed dyslipidemia. Table 11: Percent Change in LDL-C by Dose of Rosuvastatin, Atorvastatin, Simvastatin, and Pravastatin From Baseline to Week 6 (LS MEAN 1) in Adult Patients with Hyperlipidemia or Mixed Dyslipidemia (Sample Sizes Ranging from 156–167 Patients Per Group) Rosuvastatin-46 2-52 3-55 4--- Atorvastatin-37-43-48-51 Simvastatin-28-35-39-46 Pravastatin-20-24-30--- Lovastatin is not directly compared to rosuvastatin in the provided text, however, it can be compared to other statins that are listed, such as simvastatin and pravastatin.

The FDA drug label does not directly compare the strength of Crestor (rosuvastatin) to lovastatin. However, based on the available data, rosuvastatin appears to be more effective in reducing LDL-C levels compared to simvastatin and pravastatin, which are in the same class of drugs as lovastatin.

• Key points:
  • Rosuvastatin reduces LDL-C levels by 46-55% at doses of 10-40 mg.
  • Simvastatin reduces LDL-C levels by 28-46% at doses of 10-80 mg.
  • Pravastatin reduces LDL-C levels by 20-30% at doses of 10-40 mg.
  • Lovastatin is not directly compared to rosuvastatin, but its efficacy can be inferred from the comparison with other statins. It is essential to note that the provided information does not allow for a direct comparison between rosuvastatin and lovastatin, and the decision on which medication to use should be based on individual patient needs and medical history 2.

From the Research

Comparison of Crestor and Lovastatin

• Crestor (rosuvastatin) is considered a more potent statin compared to lovastatin, with greater efficacy in reducing total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels 3, 4, 5.
• Studies have shown that rosuvastatin is more effective than lovastatin in achieving National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III LDL-C goals 4.
• The VOYAGER meta-analysis found that rosuvastatin doses are equivalent to doses 3-3.5 times higher for atorvastatin and 7-8 times higher for simvastatin in terms of reducing LDL-C and non-HDL-C levels 6.
• A retrospective observational study found that switching from rosuvastatin to a less than equivalent dose of simvastatin did not result in significant increases in LDL levels, suggesting that rosuvastatin is more potent than simvastatin, and by extension, lovastatin 7.

Efficacy of Crestor

• Rosuvastatin has been shown to provide a significant increase in high-density lipoprotein cholesterol (HDL-C) levels, which is beneficial for cardiovascular health 3.
• The JUPITER trial found that rosuvastatin significantly reduced cardiovascular events in low-risk patients with raised C-reactive protein but normal LDL-C levels 3.
• Rosuvastatin has been found to cause regression of atherosclerosis in secondary prevention patients and has a potential future role in delaying atherosclerosis in primary prevention patients 5.

Comparison of Statin Potency

• The potency of statins can be compared based on their ability to reduce LDL-C and non-HDL-C levels, with rosuvastatin being one of the most potent statins available 4, 6.
• Lovastatin is considered a less potent statin compared to rosuvastatin, with lower efficacy in reducing LDL-C and non-HDL-C levels 6, 7.