Is rosuvastatin (generic name for Crestor) more effective in individuals of African descent?

From the Guidelines

Rosuvastatin is not specifically better for Black people compared to other statins, though it is effective across all racial groups. When prescribing statins for Black individuals, healthcare providers should consider the same factors as for other patients: cardiovascular risk, cholesterol levels, potential drug interactions, and individual response. The typical starting dose of rosuvastatin is 5-10 mg once daily, which can be adjusted based on response. Some studies suggest that Black individuals may have slightly different responses to certain statins, but these differences are not significant enough to make rosuvastatin the automatic first choice.

Key Considerations

• The 2018 AHA/ACC/multisociety cholesterol guideline reported no differences in sensitivity to statin dosing in Hispanic/Latino-Americans and Black persons/African Americans as compared with non-Hispanic White Americans 1, 2.
• The guideline also states that it is reasonable for clinicians to consider race and ethnic features that can influence ASCVD risk and to adjust the intensity of statin therapy accordingly 3.
• What's most important is regular monitoring of cholesterol levels and liver function tests after starting any statin, including rosuvastatin.
• Lifestyle modifications such as healthy diet, regular exercise, and smoking cessation remain essential components of cardiovascular disease prevention alongside medication therapy.
• The best statin choice should be individualized based on the patient's specific health profile rather than race alone.

Racial and Ethnic Considerations

• Higher rosuvastatin plasma levels have been reported in people of Japanese, Chinese, Malay, and Asian-Indian heritage compared with White individuals 1, 2, 3.
• However, there is no significant difference in the response to statin therapy among Black individuals compared to other racial groups 1, 2.
• The 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk states that the generalizability of the recommendations provided in this document for the use of all statin add-on therapies for individuals from ethnic minorities remains somewhat uncertain 3.

From the FDA Drug Label

Racial or Ethnic Groups A population pharmacokinetic analysis revealed no clinically relevant differences in pharmacokinetics among White, Hispanic or Latino ethnicity, and Black or Afro-Caribbean groups

The FDA drug label does not provide information that suggests rosuvastatin is more effective in individuals of African descent. In fact, it states that there are no clinically relevant differences in pharmacokinetics among different racial or ethnic groups, including Black or Afro-Caribbean groups 4.

From the Research

Efficacy of Rosuvastatin in Individuals of African Descent

• The study 5 compared the efficacy and safety of rosuvastatin and atorvastatin in African-American patients and found that rosuvastatin improved the overall lipid profile of hypercholesterolemic African-Americans better than milligram-equivalent doses of atorvastatin.
• The results showed that rosuvastatin 10 and 20 mg significantly reduced low-density lipoprotein cholesterol, total cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B concentrations compared to atorvastatin.
• Additionally, rosuvastatin 10 mg increased high-density lipoprotein cholesterol significantly more than atorvastatin 20 mg.

Comparison with Other Statins

• Studies 6, 7, 8, and 9 compared the efficacy and safety of rosuvastatin with other statins, including atorvastatin, simvastatin, and pravastatin, and found that rosuvastatin was more effective in lowering low-density lipoprotein cholesterol and improving lipid profiles.
• Rosuvastatin was also found to be generally well-tolerated, with a safety profile similar to that of other statins.

Specific Findings in African-American Patients

• The study 5 found that larger proportions of rosuvastatin-treated patients than atorvastatin-treated patients achieved National Cholesterol Education Program Adult Treatment Panel III low-density lipoprotein cholesterol goals.
• The median high-sensitivity C-reactive protein levels were significantly reduced with rosuvastatin 20 mg and atorvastatin 20 mg among all patients, and with rosuvastatin 10 and 20 mg and atorvastatin 20 mg in those patients with a baseline C-reactive protein level > 2.0 mg/L.