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, and all statins, including rosuvastatin, are effective for lowering cholesterol in patients of all racial backgrounds. The most recent and highest quality study, published in 2022 1, suggests that while there may be some differences in response to statins among different racial and ethnic groups, these differences are generally modest. The standard starting dose of rosuvastatin is typically 5-10 mg once daily, which can be adjusted based on individual response.

When prescribing statins, healthcare providers should consider each patient's specific:

• Cardiovascular risk factors
• Comorbidities
• Potential drug interactions
• Individual response rather than making decisions based primarily on race. Genetic factors that affect statin metabolism can vary among individuals of any racial background. It's essential for patients to have regular follow-up appointments to monitor cholesterol levels and potential side effects, regardless of racial background.

The choice of statin should be individualized based on the patient's overall clinical picture, cholesterol targets, and tolerance to the medication. According to the 2018 AHA/ACC/multisociety cholesterol guideline 1, there are no differences in sensitivity to statin dosing in Hispanic/Latino-Americans and Black persons/African Americans as compared with non-Hispanic White Americans. However, the guideline also notes that higher rosuvastatin plasma levels have been reported in people of Japanese, Chinese, Malay, and Asian-Indian heritage compared with White individuals.

In terms of specific considerations for Black individuals, the evidence suggests that they may have a slightly better response to rosuvastatin compared to some other statins, though these differences are generally modest 1. The IRIS trial (Investigation of Rosuvastatin in South Asians) randomized South Asians residing in the United States and Canada to either rosuvastatin or atorvastatin, and found that both statins were well tolerated and effective in this population 1.

Overall, the evidence suggests that rosuvastatin is a effective statin for lowering cholesterol in patients of all racial backgrounds, and that the choice of statin should be individualized based on the patient's overall clinical picture, rather than their racial background. The most important consideration is to choose a statin that is effective and well-tolerated by the individual patient, regardless of their racial background.

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 2.

From the Research

Efficacy of Rosuvastatin in Individuals of African Descent

• The study 3 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 4, 5, 6, and 7 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 3 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.