What is the recommended dosing for a 42-year-old female with type 2 diabetes on Crestor (rosuvastatin) 10mg with elevated Low-Density Lipoprotein (LDL) and hypertriglyceridemia?

From the Guidelines

For a 42-year-old female with type 2 diabetes on Crestor (rosuvastatin) 10mg who has elevated LDL and hypertriglyceridemia, I recommend increasing the rosuvastatin dose to 20mg daily, as supported by the most recent guidelines 1. If this doesn't achieve target LDL levels (typically <70 mg/dL for diabetic patients with cardiovascular risk factors) after 4-6 weeks, consider further increasing to 40mg daily. For the hypertriglyceridemia component, adding fenofibrate 145mg daily or omega-3 fatty acids (2-4g daily) could be beneficial, particularly if triglycerides remain above 500 mg/dL despite statin therapy, as suggested by previous studies 1. Monitor liver function tests and creatine kinase at baseline, 12 weeks after initiation, and periodically thereafter. Patients should take rosuvastatin at the same time each day, with or without food, while fenofibrate should be taken with meals to enhance absorption. This combination approach targets both LDL reduction through increased statin dosing and triglyceride reduction through additional agents, addressing the dual lipid abnormalities common in type 2 diabetes. Lifestyle modifications including dietary changes, regular exercise, and optimal diabetes management remain essential components of treatment, as emphasized in guidelines for cardiovascular disease prevention in women 1. Key considerations include:

• The patient's age and diabetes status, which may influence the choice of lipid-lowering therapy and target lipid levels 1.
• The potential for drug interactions, particularly with fenofibrate and statins, which may increase the risk of myopathy 1.
• The importance of regular monitoring of lipid levels, liver function, and other safety parameters to ensure the safe and effective use of lipid-lowering therapies 1.

From the FDA Drug Label

2.2 Recommended Dosage in Adult Patients The dosage range for rosuvastatin tablets is 5 mg to 40 mg orally once daily. The recommended dose of rosuvastatin tablets depends on a patient’s indication for usage, LDL-C, and individual risk for CV events.

The patient is already on Crestor (rosuvastatin) 10mg. Given the patient has elevated LDL and triglycerides, the dosage may need to be adjusted.

• The dosage range for adult patients is 5 mg to 40 mg orally once daily.
• The recommended dose depends on the patient's indication for usage, LDL-C, and individual risk for CV events. Since the patient is already on 10mg, the dose could be increased up to 40 mg once daily, but this decision should be made by a healthcare professional considering the patient's individual risk factors and response to the current dose 2.

From the Research

Patient Profile

• 42-year-old female with type 2 diabetes
• Currently on Crestor (rosuvastatin) 10mg
• Elevated Low-Density Lipoprotein (LDL) and hypertriglyceridemia

Recommended Dosing

Based on the provided studies, the recommended dosing for this patient is not explicitly stated. However, the following points can be considered:

• A study published in 2011 3 found that the combination of rosuvastatin and fenofibric acid resulted in a significantly higher proportion of patients with type 2 diabetes mellitus achieving individual and combined lipid targets compared to corresponding-dose rosuvastatin monotherapies.
• Another study published in 2009 4 compared the effects of rosuvastatin and fenofibrate on lipid levels and markers of inflammation in patients with type 2 diabetes and low high-density lipoprotein cholesterol. The study found that both rosuvastatin and fenofibrate decreased total cholesterol, LDL cholesterol, and triglycerides, and increased HDL cholesterol.
• A study published in 2001 5 compared the effects of atorvastatin and fenofibrate on lipoprotein profiles, LDL subfraction distribution, and hemorheologic parameters in patients with type 2 diabetes mellitus and mixed hyperlipoproteinemia. The study found that atorvastatin decreased all LDL subfractions, while fenofibrate predominantly decreased triglyceride concentrations and induced a shift in LDL subtype distribution.

Considerations

• The patient's current dose of rosuvastatin is 10mg, which may not be sufficient to achieve optimal lipid levels.
• The addition of fenofibric acid or fenofibrate to the patient's treatment regimen may be considered to improve lipid profiles and reduce cardiovascular risk.
• The patient's type 2 diabetes and elevated LDL and triglycerides increase her cardiovascular risk, and therefore, aggressive lipid-lowering therapy may be necessary 6, 7.