Does Crestor (Rosuvastatin) Decrease Triglycerides?
Yes, Crestor (rosuvastatin) significantly decreases triglyceride levels, with reductions ranging from 21-43% depending on dosage. 1
Mechanism and Efficacy
Rosuvastatin is a synthetic statin that works by inhibiting HMG-CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis. While its primary effect is on LDL cholesterol reduction, it also has significant triglyceride-lowering properties:
In patients with primary hypertriglyceridemia (baseline TG levels 273-817 mg/dL), rosuvastatin demonstrated dose-dependent reductions in triglycerides 1:
- 5 mg: 21% reduction
- 10 mg: 37% reduction
- 20 mg: 37% reduction
- 40 mg: 43% reduction
In patients with primary dysbetalipoproteinemia (Type III hyperlipidemia), rosuvastatin reduced triglycerides by 1:
- 10 mg: 40.1% reduction
- 20 mg: 43.0% reduction
Comparison to Other Lipid-Lowering Agents
When considering triglyceride-lowering potency among various agents:
Fibrates offer the most triglyceride reduction, followed by immediate-release niacin, omega-3 methyl esters, extended-release niacin, statins (including rosuvastatin), and ezetimibe 2
While rosuvastatin effectively lowers triglycerides, it is not the most potent agent specifically for triglyceride reduction. However, its combined effects on the entire lipid profile make it valuable in mixed dyslipidemia 3
Clinical Applications
Rosuvastatin is particularly useful in:
Mixed dyslipidemia: Patients with elevated LDL-C and triglycerides can benefit from rosuvastatin's dual effects 4
Hypertriglyceridemia: For patients with triglyceride levels between 150-499 mg/dL, rosuvastatin can be an effective option, especially when LDL-C is also elevated 5
Primary prevention: In the JUPITER trial, rosuvastatin significantly reduced triglycerides while simultaneously improving other lipid parameters 1
Dosing Considerations
- Starting dose is typically 10 mg daily, which can reduce triglycerides by approximately 37% 1
- Higher doses (20-40 mg) may provide additional triglyceride reduction but with diminishing returns 1
- For severe hypertriglyceridemia (>500 mg/dL), fibrates are generally preferred as first-line therapy to prevent pancreatitis, with statins as adjunctive therapy 5
Important Caveats
While rosuvastatin reduces triglycerides, fibrates remain the most potent triglyceride-lowering agents and may be preferred when triglyceride reduction is the primary goal 2
For patients with severe hypertriglyceridemia (>500 mg/dL), the primary focus should be on preventing pancreatitis, for which fibrates are generally considered first-line therapy 5
Combination therapy with statins and fibrates increases the risk of myopathy and should generally be approached with caution 5
Lifestyle modifications remain foundational for triglyceride management, including weight loss, alcohol restriction, limiting added sugars, and regular exercise 5
In conclusion, while Crestor (rosuvastatin) is not the most potent triglyceride-lowering agent available, it does provide clinically significant triglyceride reductions while simultaneously improving other lipid parameters, making it a valuable option for patients with mixed dyslipidemia or those who require both LDL-C and triglyceride reduction.