Does Crestor (rosuvastatin) decrease triglyceride levels?

Does Crestor Decrease Triglycerides?

Yes, Crestor (rosuvastatin) significantly decreases triglyceride levels, with reductions ranging from 20-40% depending on dose, making it an effective option for managing hypertriglyceridemia, especially when combined with LDL-lowering goals.

Mechanism and Efficacy

Rosuvastatin, like other statins, primarily targets LDL cholesterol reduction, but it also has significant triglyceride-lowering effects:

• Higher doses of statins, including rosuvastatin, can be moderately effective at reducing triglyceride levels 1
• In patients with hypertriglyceridemia, rosuvastatin demonstrates dose-dependent triglyceride reduction:
  • 5-40 mg doses produce significant mean reductions in triglycerides compared with placebo (-18% to -40%) 2
  • Median reductions in triglycerides with rosuvastatin at 5-80 mg ranged from -21% to -46% 2
• FDA data confirms that rosuvastatin reduces triglycerides by 35-43% at doses of 5-40 mg 3

Comparative Efficacy

When compared to other statins, rosuvastatin shows favorable triglyceride-lowering effects:

• Rosuvastatin 40 mg and atorvastatin 80 mg cause similar decreases in triglyceride levels (-24% and -26%, respectively) 4
• In Mexican patients with hypertriglyceridemia, rosuvastatin 10 mg and 20 mg reduced triglycerides by 26.6% and 32.19%, respectively, compared to 7.58% with placebo 5

Clinical Application

For patients with elevated triglycerides, the approach should follow these principles:

For Moderate Hypertriglyceridemia (150-499 mg/dL):

1. Improved glycemic control (if diabetic) is the initial step 1
2. Statin therapy, including rosuvastatin, is appropriate when LDL-C reduction is also needed 1
3. Higher doses of rosuvastatin may be sufficient for both LDL and triglyceride reduction 1

For Severe Hypertriglyceridemia (≥500 mg/dL):

1. Primary focus is on preventing pancreatitis
2. Fibrates are first-line treatment for severe hypertriglyceridemia 1
3. Statins alone are not recommended for severe hypertriglyceridemia but may be used in combination therapy 1

Important Considerations

• Statins, including rosuvastatin, have a modest triglyceride-lowering effect (typically 10-15%) at standard doses, but higher doses can achieve greater reductions 1
• For patients with both high LDL and triglycerides, high-dose statin therapy may be appropriate 1
• In patients with diabetes and hypertriglyceridemia, improved glycemic control should be pursued first, followed by statin therapy 1
• For patients with severely elevated triglycerides (>500 mg/dL), statins should not be used alone but may be combined with fibrates or other triglyceride-lowering agents 1

Potential Pitfalls

• Combining statins with fibrates (especially gemfibrozil) increases the risk of myositis 1
• If combination therapy is needed, fenofibrate is generally safer than gemfibrozil when used with statins 1
• Patients with renal disease may have increased risk of myositis with statin-fibrate combinations 1
• Monitoring for adverse effects is essential, particularly with high-dose statin therapy or combination treatments

In summary, Crestor (rosuvastatin) effectively reduces triglyceride levels, with greater reductions seen at higher doses. While primarily used for LDL reduction, its triglyceride-lowering effect makes it valuable in managing mixed dyslipidemia.