What is the recommended dose of rosuvastatin ( Crestor ) for asymptomatic carotid stenosis?

From the Guidelines

The recommended dose of rosuvastatin for asymptomatic carotid stenosis is 20 mg daily, as high-intensity statin therapy is generally recommended for patients with clinical atherosclerotic cardiovascular disease (ASCVD) 1. For patients with asymptomatic carotid stenosis, the goal of statin therapy is to reduce the risk of major adverse cardiovascular events, including stroke.

• High-intensity statin therapy, such as rosuvastatin 20 mg daily, has been shown to reduce LDL-C by approximately 50% and decrease the risk of ASCVD events 1.
• The starting dose of rosuvastatin is often 20 mg once daily, which can be adjusted based on individual response and tolerability.
• Treatment should be continued indefinitely as this is a chronic condition requiring ongoing management.
• Rosuvastatin should be taken at the same time each day, with or without food.
• The medication works by reducing cholesterol production in the liver and increasing LDL receptor activity, which helps lower LDL cholesterol levels and may stabilize carotid plaques, potentially slowing progression of stenosis and reducing stroke risk.
• Regular monitoring of lipid levels and liver function tests is important, especially in the first year of treatment.
• Patients should also be counseled on lifestyle modifications including diet, exercise, and smoking cessation as complementary approaches to medication therapy.

From the FDA Drug Label

To reduce the risk of major adverse cardiovascular (CV) events (CV death, nonfatal myocardial infarction, nonfatal stroke, or an arterial revascularization procedure) in adults without established coronary heart disease who are at increased risk of CV disease based on age, high-sensitivity C-reactive protein (hsCRP) ≥2 mg/L, and at least one additional CV risk factor. 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 recommended dose of rosuvastatin for asymptomatic carotid stenosis is not explicitly stated in the drug label. However, based on the information provided, the dosage range for rosuvastatin tablets is 5 mg to 40 mg orally once daily, and the recommended dose depends on the patient's indication for usage, LDL-C, and individual risk for CV events.

• The drug label does provide information on reducing the risk of major adverse cardiovascular events in adults without established coronary heart disease who are at increased risk of CV disease.
• Asymptomatic carotid stenosis may be considered a CV risk factor, but the label does not provide a specific recommended dose for this condition. 2

From the Research

Recommended Dose of Rosuvastatin for Asymptomatic Carotid Stenosis

The recommended dose of rosuvastatin for asymptomatic carotid stenosis can be determined based on the following studies:

• A study published in 2014 3 used rosuvastatin 5-20 mg/day to lower LDL-C levels to < 80 mg/dl in patients with asymptomatic carotid atherosclerosis.
• A study published in 2010 4 used rosuvastatin 10 mg/day for 1 year to reduce intima-media thickness in patients with hypercholesterolemia and asymptomatic carotid artery disease.
• A study published in 2015 5 used rosuvastatin to achieve an LDL cholesterol goal of ≤1.8 mmoles/liter (≤70 mg/dl) in patients with inflammatory joint disease and carotid plaques.

Key Findings

• The studies suggest that rosuvastatin can be effective in reducing LDL-C levels and improving lipid profiles in patients with asymptomatic carotid stenosis.
• The dose of rosuvastatin used in these studies ranged from 5-20 mg/day, with 10 mg/day being a common dose used in several studies.
• The studies demonstrate that rosuvastatin can help reduce carotid plaque lipid content, intima-media thickness, and LDL-C levels, which are all important factors in the management of asymptomatic carotid stenosis.

Dose of Rosuvastatin

• Based on the studies, the recommended dose of rosuvastatin for asymptomatic carotid stenosis is likely to be in the range of 5-20 mg/day, with 10 mg/day being a commonly used dose.
• However, the exact dose may depend on individual patient factors, such as LDL-C levels, lipid profiles, and other cardiovascular risk factors.
• It is essential to consult with a healthcare professional to determine the appropriate dose of rosuvastatin for each patient.