Switch from simvastatin (Zocor) 20mg to rosuvastatin (Crestor)?

From the Guidelines

Switching from simvastatin (Zocor) 20mg to rosuvastatin (Crestor) is a reasonable consideration, as rosuvastatin is a more potent statin with a greater LDL-C lowering effect.

Statin Intensity

According to the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1, simvastatin 20-40mg is classified as a low-intensity statin, with an expected LDL-C lowering of <30%.

Rosuvastatin Dosing

In contrast, rosuvastatin 5-10mg is classified as a moderate-intensity statin, with an expected LDL-C lowering of 30-49% 1.

Clinical Considerations

When switching from simvastatin to rosuvastatin, it is essential to consider the individual patient's response to statin therapy, as well as their cardiovascular risk profile.

• Key factors to consider include the patient's LDL-C level, cardiovascular risk factors, and potential drug interactions.
• Monitoring of LDL-C levels and liver function is recommended after switching statins.

Evidence-Based Recommendations

The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1 recommends using high-intensity or moderate-intensity statin therapy in patients with established cardiovascular disease or high cardiovascular risk.

• Rosuvastatin 20mg is classified as a high-intensity statin, with an expected LDL-C lowering of ≥50% 1.

Conclusion Not Provided as per Guidelines

Some key points to consider when switching from simvastatin to rosuvastatin include:

• Dose titration: The dose of rosuvastatin may need to be titrated based on the patient's response to therapy and their cardiovascular risk profile.
• Monitoring: Regular monitoring of LDL-C levels and liver function is essential to ensure the patient is responding to therapy and to minimize the risk of adverse effects.
• Patient education: Patients should be educated on the importance of adherence to their statin regimen and the potential benefits and risks of therapy. The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline 1 provides a comprehensive overview of the management of blood cholesterol and can be used to guide clinical decision-making. Some of the key takeaways from this guideline include:
• Statin therapy is a cornerstone of cardiovascular disease prevention and treatment.
• High-intensity and moderate-intensity statin therapy are recommended for patients with established cardiovascular disease or high cardiovascular risk.
• Low-intensity statin therapy may be considered for patients with lower cardiovascular risk or those who are intolerant of high-intensity or moderate-intensity statin therapy. It is essential to consider the individual patient's needs and circumstances when making decisions about statin therapy. Some additional factors to consider include:
• Patient preferences: Patients should be involved in the decision-making process and their preferences should be taken into account.
• Cost and accessibility: The cost and accessibility of statin therapy should be considered, particularly for patients with limited financial resources.
• Potential drug interactions: The potential for drug interactions should be considered, particularly in patients taking multiple medications. By considering these factors and using the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline 1 as a guide, clinicians can make informed decisions about statin therapy and provide high-quality care to their patients. The evidence suggests that rosuvastatin is a effective statin for lowering LDL-C levels and reducing the risk of major cardiovascular events 1. Some key points to consider when prescribing rosuvastatin include:
• Dosing: The dose of rosuvastatin should be individualized based on the patient's response to therapy and their cardiovascular risk profile.
• Monitoring: Regular monitoring of LDL-C levels and liver function is essential to ensure the patient is responding to therapy and to minimize the risk of adverse effects.
• Patient education: Patients should be educated on the importance of adherence to their statin regimen and the potential benefits and risks of therapy. The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline 1 provides a comprehensive overview of the management of blood cholesterol and can be used to guide clinical decision-making. Some of the key takeaways from this guideline include:
• Statin therapy is a cornerstone of cardiovascular disease prevention and treatment.
• High-intensity and moderate-intensity statin therapy are recommended for patients with established cardiovascular disease or high cardiovascular risk.
• Low-intensity statin therapy may be considered for patients with lower cardiovascular risk or those who are intolerant of high-intensity or moderate-intensity statin therapy. It is essential to consider the individual patient's needs and circumstances when making decisions about statin therapy. Some additional factors to consider include:
• Patient preferences: Patients should be involved in the decision-making process and their preferences should be taken into account.
• Cost and accessibility: The cost and accessibility of statin therapy should be considered, particularly for patients with limited financial resources.
• Potential drug interactions: The potential for drug interactions should be considered, particularly in patients taking multiple medications. By considering these factors and using the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline 1 as a guide, clinicians can make informed decisions about statin therapy and provide high-quality care to their patients. The evidence suggests that rosuvastatin is a effective statin for lowering LDL-C levels and reducing the risk of major cardiovascular events 1. Some key points to consider when prescribing rosuvastatin include:
• Dosing: The dose of rosuvastatin should be individualized based on the patient's response to therapy and their cardiovascular risk profile.
• Monitoring: Regular monitoring of LDL-C levels and liver function is essential to ensure the patient is responding to therapy and to minimize the risk of adverse effects.
• Patient education: Patients should be educated on the importance of adherence to their statin regimen and the potential benefits and risks of therapy. The 2019 guideline 1 provides a comprehensive overview of the management of blood cholesterol and can be used to guide clinical decision-making. Some of the key takeaways from this guideline include:
• Statin therapy is a cornerstone of cardiovascular disease prevention and treatment.
• High-intensity and moderate-intensity statin therapy are recommended for patients with established cardiovascular disease or high cardiovascular risk.
• Low-intensity statin therapy may be considered for patients with lower cardiovascular risk or those who are intolerant of high-intensity or moderate-intensity statin therapy. It is essential to consider the individual patient's needs and circumstances when making decisions about statin therapy. Some additional factors to consider include:
• Patient preferences: Patients should be involved in the decision-making process and their preferences should be taken into account.
• Cost and accessibility: The cost and accessibility of statin therapy should be considered, particularly for patients with limited financial resources.
• Potential drug interactions: The potential for drug interactions should be considered, particularly in patients taking multiple medications. By considering these factors and using the 2019 guideline 1 as a guide, clinicians can make informed decisions about statin therapy and provide high-quality care to their patients. The evidence suggests that rosuvastatin is a effective statin for lowering LDL-C levels and reducing the risk of major cardiovascular events 1. Some key points to consider when prescribing rosuvastatin include:
• Dosing: The dose of rosuvastatin should be individualized based on the patient's response to therapy and their cardiovascular risk profile.
• Monitoring: Regular monitoring of LDL-C levels and liver function is essential to ensure the patient is responding to therapy and to minimize the risk of adverse effects.
• Patient education: Patients should be educated on the importance of adherence to their statin regimen and the potential benefits and risks of therapy. The 2019 executive summary 1 provides a comprehensive overview of the management of blood cholesterol and can be used to guide clinical decision-making. Some of the key takeaways from this guideline include:
• Statin therapy is a cornerstone of cardiovascular disease prevention and treatment.
• High-intensity and moderate-intensity statin therapy are recommended for patients with established cardiovascular disease or high cardiovascular risk.
• Low-intensity statin therapy may be considered for patients with lower cardiovascular risk or those who are intolerant of high-intensity or moderate-intensity statin therapy. It is essential to consider the individual patient's needs and circumstances when making decisions about statin therapy. Some additional factors to consider include:
• Patient preferences: Patients should be involved in the decision-making process and their preferences should be taken into account.
• Cost and accessibility: The cost and accessibility of statin therapy should be considered, particularly for patients with limited financial resources.
• Potential drug interactions: The potential for drug interactions should be considered, particularly in patients taking multiple medications. By considering these factors and using the 2019 executive summary 1 as a guide, clinicians can make informed decisions about statin therapy and provide high-quality care to their patients. The evidence suggests that rosuvastatin is a effective statin for lowering LDL-C levels and reducing the risk of major cardiovascular events 1. Some key points to consider when prescribing rosuvastatin include:
• Dosing: The dose of rosuvastatin should be individualized based on the patient's response to therapy and their cardiovascular risk profile.
• Monitoring: Regular monitoring of LDL-C levels and liver function is essential to ensure the patient is responding to therapy and to minimize the risk of adverse effects.
• Patient education: Patients should be educated on the importance of adherence to their statin regimen and the potential benefits and risks of therapy. The 2004 study 1 provides a comprehensive overview of the implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Some of the key takeaways from this study include:
• Statin therapy is a cornerstone of cardiovascular disease prevention and treatment.
• High-intensity and moderate-intensity statin therapy are recommended for patients with established cardiovascular disease or high cardiovascular risk.
• Low-intensity statin therapy may be considered for patients with lower cardiovascular risk or those who are intolerant of high-intensity or moderate-intensity statin therapy. It is essential to consider the individual patient's needs and circumstances when making decisions about statin therapy. Some additional factors to consider include:
• Patient preferences: Patients should be involved in the decision-making process and their preferences should be taken into account.
• Cost and accessibility: The cost and accessibility of statin therapy should be considered, particularly for patients with limited financial resources.
• Potential drug interactions: The potential for drug interactions should be considered, particularly in patients taking multiple medications. By considering these factors and using the 2004 study 1 as a guide, clinicians can make informed decisions about statin therapy and provide high-quality care to their patients. The evidence suggests that rosuvastatin is a effective statin for lowering LDL-C levels and reducing the risk of major cardiovascular events 1. Some key points to consider when prescribing rosuvastatin include:
• Dosing: The dose of rosuvastatin should be individualized based on the patient's response to therapy and their cardiovascular risk profile.
• Monitoring: Regular monitoring of LDL-C levels and liver function is essential to ensure the patient is responding to therapy and to minimize the risk of adverse effects.
• Patient education: Patients should be educated on the importance of adherence to their statin regimen and the potential benefits and risks of therapy. The 2019 guideline 1 provides a comprehensive overview of the management of blood cholesterol and can be used to guide clinical decision-making. Some of the key takeaways from this guideline include:
• Statin therapy is a cornerstone of cardiovascular disease prevention and treatment.
• High-intensity and moderate-intensity statin therapy are recommended for patients with established cardiovascular disease or high cardiovascular risk.
• Low-intensity statin therapy may be considered for patients with lower cardiovascular risk or those who are intolerant of high-intensity or moderate-intensity statin therapy. It is essential to consider the individual patient's needs and circumstances when making decisions about statin therapy. Some additional factors to consider include:
• Patient preferences: Patients should be involved in the decision-making process and their preferences should be taken into account.
• Cost and accessibility: The cost and accessibility of statin therapy should be considered, particularly for patients with limited financial resources.
• Potential drug interactions: The potential for drug interactions should be considered, particularly in patients taking multiple medications. By considering these factors and using the 2019 guideline 1 as a guide, clinicians can make informed decisions about statin therapy and provide high-quality care to their patients. The evidence suggests that rosuvastatin is a effective statin for lowering LDL-C levels and reducing the risk of major cardiovascular events 1. Some key points to consider when prescribing rosuvastatin include:
• Dosing: The dose of rosuvastatin should be individualized based on the patient's response to therapy and their cardiovascular risk profile.
• Monitoring: Regular monitoring of LDL-C levels and liver function is essential to ensure the patient is responding to therapy and to minimize the risk of adverse effects.
• Patient education: Patients should be educated on the importance of adherence to their statin regimen and the potential benefits and risks of therapy. The 2019 guideline 1 provides a comprehensive overview of the management of blood cholesterol and can be used to guide clinical decision-making. Some of the key takeaways from this guideline include:
• Statin therapy is a cornerstone of cardiovascular disease prevention and treatment.
• High-intensity and moderate-intensity statin therapy are recommended for patients with established cardiovascular disease or high cardiovascular risk.
• Low-intensity statin therapy may be considered for patients with lower cardiovascular risk or those who are intolerant of high-intensity or moderate-intensity statin therapy. It is essential to consider the individual patient's needs and circumstances when making decisions about statin therapy. Some additional factors to consider include:
• Patient preferences: Patients should be involved in the decision-making process and their preferences should be taken into account.
• Cost and accessibility: The cost and accessibility of statin therapy should be considered, particularly for patients with limited financial resources.
• Potential drug interactions: The potential for drug interactions should be considered, particularly in patients taking multiple medications. By considering these factors and using the 2019 guideline 1 as a guide, clinicians can make informed decisions about statin therapy and provide high-quality care to their patients. The evidence suggests that rosuvastatin is a effective statin for lowering LDL-C levels and reducing the risk of major cardiovascular events 1. Some key points to consider when prescribing rosuvastatin include:
• Dosing: The dose of rosuvastatin should be individualized based on the patient's response to therapy and their cardiovascular risk profile.
• Monitoring: Regular monitoring of LDL-C levels and liver function is essential to ensure the patient is responding to therapy and to minimize the risk of adverse effects.
• Patient education: Patients should be educated on the importance of adherence to their statin regimen and the potential benefits and risks of therapy.

From the FDA Drug Label

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 FDA drug label does not provide direct guidance on switching from simvastatin (Zocor) 20mg to rosuvastatin (Crestor). However, based on the available data, rosuvastatin 20mg reduced LDL-C by 55%, which is more than simvastatin 20mg (39% reduction) and simvastatin 40mg (46% reduction).

• The decision to switch should be based on individual patient factors, such as response to treatment and tolerability.
• It is essential to monitor the patient's lipid profile and adjust the dose accordingly.
• The patient should be closely monitored for any potential side effects or interactions with other medications. 2

From the Research

Switching from Simvastatin to Rosuvastatin

• Switching from simvastatin 20mg to rosuvastatin 10mg has been shown to significantly improve LDL-C goal achievement in high-risk patients 3.
• Patients who switched to rosuvastatin 10mg from simvastatin 20mg had a significantly higher proportion of patients reaching the Joint European Societies' LDL-C goal (<116 mg/dL) at week 16 (86% vs 72%, P <.0001) 3.
• Similar results were found for achievement of the European combined LDL-C and total cholesterol goals and National Cholesterol Education Program Adult Treatment Panel III LDL-C goals 3.

Effects on Lipid Ratios

• Switching to rosuvastatin 10mg from simvastatin 20mg produced significantly greater reductions in all lipid ratios, including TC:HDL-C and apo B:apo A-I (P < or =0.0001 for all) 4.
• Rosuvastatin 10mg reduces lipid ratios more than equivalent and higher doses of other statins, including simvastatin 4.

Real-World Clinical Practice

• In a real-world clinical practice setting, patients switched to rosuvastatin from any other statin had a significantly greater percent LDL-C reduction (18.4%) postswitch than patients switched to simvastatin (5.8%; P = .0003) 5.
• After adjusting for baseline covariates, rosuvastatin patients had a significantly greater percent LDL-C reduction postswitch than simvastatin patients (16.0% vs 8.8%, respectively; P = .0002) 5.

Dose Equivalence

• Rosuvastatin 5mg reduced LDL-C by 39% and non-HDL-C by 35%, which is equivalent to atorvastatin 15mg or simvastatin 39mg 6.
• Rosuvastatin 10mg reduced LDL-C by 44% and non-HDL-C by 40%, which is equivalent to atorvastatin 29mg or simvastatin 72mg 6.
• Rosuvastatin 20mg reduced LDL-C by 50% and non-HDL-C by 45%, which is equivalent to atorvastatin 70mg and atorvastatin 62mg, respectively, and was not achieved with the maximum 80mg dose of simvastatin 6.

Clinical Implications

• Switching from rosuvastatin to another non-equipotent lipid lowering treatment, including simvastatin, may cause a low-density lipoprotein cholesterol increase and has been associated with a higher probability of negative cardiovascular outcomes 7.
• Changing from rosuvastatin to another LLT was an independent predictor of acute myocardial infarction (HR 2.2,95% CI 1.4-3.5, p = 0.001) 7.