From the Guidelines
Rosuvastatin is more effective than simvastatin in lowering LDL-C levels.
Comparative Efficacy of Simvastatin vs Rosuvastatin
- The American College of Cardiology/American Heart Association guideline on the management of blood cholesterol states that high-intensity statin therapy, which includes rosuvastatin 20 mg, typically lowers LDL-C levels by ≥50%, while simvastatin 20-40 mg is considered a moderate-intensity statin therapy, lowering LDL-C levels by 30% to 49% 1.
- A study published in the Journal of the American College of Cardiology estimated that rosuvastatin 5-10 mg reduces LDL-C levels by 39-45%, while simvastatin 20-40 mg reduces LDL-C levels by 35-41% 1.
- The Standards of Medical Care in Diabetes-2018 also support the use of rosuvastatin as a high-intensity statin therapy, with a dose of 20-40 mg, while simvastatin 20-40 mg is considered a moderate-intensity statin therapy 1.
- Overall, the evidence suggests that rosuvastatin is more effective than simvastatin in lowering LDL-C levels, particularly at high-intensity doses.
- The choice of statin therapy should be individualized based on patient characteristics, such as cardiovascular risk factors and potential drug interactions.
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---
The comparative efficacy of simvastatin vs rosuvastatin is as follows:
- LDL-C reduction: Rosuvastatin reduced LDL-C more than simvastatin at doses of 10 mg, 20 mg, and 40 mg.
- Dose comparison:
- Rosuvastatin 10 mg reduced LDL-C by 46%, while simvastatin 10 mg reduced LDL-C by 28%.
- Rosuvastatin 20 mg reduced LDL-C by 52%, while simvastatin 20 mg reduced LDL-C by 35%.
- Rosuvastatin 40 mg reduced LDL-C by 55%, while simvastatin 40 mg reduced LDL-C by 39%.
- Rosuvastatin did not have an 80 mg dose, while simvastatin 80 mg reduced LDL-C by 46%. 2
From the Research
Comparative Efficacy of Simvastatin vs Rosuvastatin
- The comparative efficacy of simvastatin vs rosuvastatin has been studied in several clinical trials and meta-analyses 3, 4, 5, 6, 7.
- A meta-analysis of 32,258 patients found that doubling the dose of each statin was accompanied by a 4% to 7% greater degree of lowering of all atherogenic lipids, with rosuvastatin resulting in greater reductions in LDL-C and non-HDL-C compared to simvastatin 3.
- Another study found that rosuvastatin was more effective than simvastatin in reducing LDL-C levels, with a 37% reduction in LDL-C compared to 27% with simvastatin 4.
- A cohort study of 1,542 diabetic patients found that rosuvastatin was the most effective statin in reducing LDL-C levels, with a 28.59% reduction compared to 16.7% with simvastatin 5.
- A randomized, open-label, parallel-group study found that rosuvastatin 10 mg resulted in a significantly higher proportion of patients achieving the 1998 European Atherosclerosis Society lipid treatment goals compared to simvastatin 20 mg 6.
- A meta-analysis of 15,800 patient exposures found that rosuvastatin resulted in significantly greater LDL-C reductions than atorvastatin and simvastatin, and significantly greater TG reductions than simvastatin 7.
Key Findings
- Rosuvastatin is generally more effective than simvastatin in reducing LDL-C and non-HDL-C levels 3, 4, 5, 6, 7.
- Rosuvastatin is also more effective than simvastatin in achieving lipid treatment goals 4, 6.
- The efficacy of simvastatin and rosuvastatin can vary depending on the dose and patient population 3, 7.
- Both simvastatin and rosuvastatin are generally well-tolerated, with similar incidence of adverse events 6.