From the Guidelines
Rosuvastatin (Crestor) is the statin that most effectively increases HDL cholesterol levels, with typical increases of 5-10%. While all statins primarily work to lower LDL ("bad") cholesterol, rosuvastatin has demonstrated the greatest ability to raise HDL ("good") cholesterol. The standard dosage ranges from 5-40mg daily, with higher doses generally producing more significant HDL elevation. Atorvastatin (Lipitor) can also increase HDL, though typically to a lesser extent than rosuvastatin.
Key Points to Consider
- The HDL-raising effect of statins occurs alongside their primary mechanism of inhibiting HMG-CoA reductase, which blocks cholesterol production in the liver.
- This dual action makes rosuvastatin particularly valuable for patients with both elevated LDL and low HDL levels, as supported by studies such as 1.
- Lifestyle modifications including regular exercise, weight management, smoking cessation, and moderate alcohol consumption can further enhance HDL levels when combined with statin therapy.
- It's essential to note that while raising HDL is generally considered beneficial, the primary goal of statin therapy remains lowering LDL cholesterol to reduce cardiovascular risk, as emphasized in 1 and 1.
Additional Considerations
- Other classes of drugs, such as fibrates and nicotinic acid, can also raise HDL-C levels, but their use may be limited by side effects and interactions with other medications, as discussed in 1 and 1.
- The combination of a statin with nicotinic acid or a fibrate may produce a marked reduction of LDL-C and a striking rise in HDL-C, but this combination should be used with caution due to the potential risk of myopathy, as noted in 1.
From the FDA Drug Label
At one year, rosuvastatin increased HDL-C and reduced LDL-C, hsCRP, total cholesterol and serum triglyceride levels (p<0. 001 for all versus placebo). Primary Hyperlipidemia in Adults Rosuvastatin reduces Total-C, LDL-C, ApoB, non-HDL-C, and TG, and increases HDL-C, in adult patients with hyperlipidemia and mixed dyslipidemia
The statin (HMG-CoA reductase inhibitor) that increases high-density lipoprotein (HDL) cholesterol is rosuvastatin 2.
- Key points:
- Rosuvastatin increases HDL-C
- Rosuvastatin reduces LDL-C, hsCRP, total cholesterol, and serum triglyceride levels
- Rosuvastatin is effective in adult patients with hyperlipidemia and mixed dyslipidemia
From the Research
Statin Effects on HDL Cholesterol
- Rosuvastatin has been found to increase high-density lipoprotein (HDL) cholesterol levels 3, 4, 5, 6, 7
- The degree of HDL cholesterol increase with rosuvastatin is approximately 10% 4, which is greater than the increase seen with other statins (approximately 5%) 4
- Rosuvastatin's ability to increase HDL cholesterol, in addition to its potent low-density lipoprotein (LDL) cholesterol reduction, makes it a valuable treatment option for patients with dyslipidemia 3, 5, 6, 7
Comparison to Other Statins
- Rosuvastatin has been shown to have a greater efficacy in increasing HDL cholesterol compared to atorvastatin 6
- Rosuvastatin's effects on HDL cholesterol are also favorable compared to other statins, such as simvastatin, pravastatin, and lovastatin 4, 5
- The increased potency of rosuvastatin in lowering LDL cholesterol and increasing HDL cholesterol makes it a useful treatment option for patients who require aggressive lipid management 3, 4, 5, 6, 7