From the Guidelines
Rosuvastatin is more efficacious than simvastatin in lowering LDL-C levels.
Efficacy Comparison
- The 2019 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% 1.
- In contrast, simvastatin 20-40 mg is classified as low- to moderate-intensity statin therapy, with an LDL-C lowering effect of <30% to 49% 1.
- A study published in the Journal of the American College of Cardiology in 2004 estimated that rosuvastatin 5-10 mg can achieve an LDL reduction of 39-45%, while simvastatin 20-40 mg can achieve an LDL reduction of 35-41% 1.
- Another study published in Circulation in 2004 reported similar findings, with rosuvastatin 5-10 mg achieving an LDL reduction of 39-45% and simvastatin 20-40 mg achieving an LDL reduction of 35-41% 1.
Key Points
- Rosuvastatin has a higher efficacy in lowering LDL-C levels compared to simvastatin.
- The choice of statin and dose should be individualized based on the patient's risk factors and response to therapy.
- High-intensity statin therapy, including rosuvastatin, is recommended for patients at high risk of cardiovascular events 1.
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 efficacy of rosuvastatin versus simvastatin can be compared based on their ability to reduce LDL-C levels.
- At doses of 10 mg, 20 mg, and 40 mg, rosuvastatin reduced LDL-C levels by 46%, 52%, and 55%, respectively.
- In comparison, simvastatin reduced LDL-C levels by 28%, 35%, and 39% at doses of 10 mg, 20 mg, and 40 mg, respectively, and by 46% at a dose of 80 mg.
- Rosuvastatin was found to reduce LDL-C significantly more than simvastatin at all comparable doses 2. It can be concluded that rosuvastatin is more effective than simvastatin in reducing LDL-C levels.
From the Research
Efficacy Comparison
- The efficacy of simvastatin versus rosuvastatin has been compared in several studies 3, 4, 5, 6, 7.
- Rosuvastatin has been shown to be more effective in reducing low-density lipoprotein (LDL) cholesterol levels compared to simvastatin in multiple studies 4, 5, 6, 7.
- A study published in the American Journal of Cardiology found that rosuvastatin 5 and 10 mg reduced LDL cholesterol significantly more than simvastatin 20 mg 4.
- Another study published in the same journal found that rosuvastatin reduced LDL cholesterol by a mean of 12% to 18% more than simvastatin across dose ranges 5.
Lipid Profile Modifications
- Rosuvastatin has been shown to have a more favorable effect on lipid profiles compared to simvastatin, with greater reductions in total cholesterol, triglycerides, and apolipoprotein B 4, 5, 7.
- A study published in the American Heart Journal found that rosuvastatin reduced LDL-C levels more than simvastatin in patients with hypercholesterolemia, with 88% and 87.5% of rosuvastatin-treated patients achieving their National Cholesterol Education Program Adult Treatment Panel II (ATP II) LDL-C goals after 52 weeks 7.
Clinical Effectiveness and Cost-Effectiveness
- Rosuvastatin has been shown to be more effective and cost-effective than simvastatin in lowering LDL-C and achieving ATP III LDL-C goals in high-risk patients 6.
- A study published in the American Journal of Managed Care found that rosuvastatin was more effective and less costly than simvastatin, with a higher percentage of patients achieving their LDL-C goals and lower annualized treatment costs 6.