What is the comparison between Atorvastatin (Lipitor) and Rosuvastatin (Crestor)?

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Dainyal Siddiqui, MD

Internal Medicine

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Manuel Jimenez, MD

Cardiology

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Franz Pierre-Louis, MD

Infectious Disease

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Last updated: March 22, 2025 • View editorial policy

From the Guidelines

Atorvastatin and rosuvastatin are both effective statins for lowering cholesterol, but rosuvastatin is generally more potent at equivalent doses, as evidenced by the most recent guidelines 1.

Comparison of Atorvastatin and Rosuvastatin

For most patients with moderate cholesterol elevation, atorvastatin 10-20 mg daily is a good starting point, while those needing more intensive lipid lowering may benefit from rosuvastatin 5-10 mg daily, according to the standards of care in diabetes-2023 1.

  • Key differences between atorvastatin and rosuvastatin include: + Potency: Rosuvastatin achieves greater LDL reduction at lower doses (rosuvastatin 10 mg is roughly equivalent to atorvastatin 20 mg) 2. + Cost: Atorvastatin is typically less expensive as a generic medication. + History of use: Atorvastatin has a longer history of use.

Considerations for Choosing Between Atorvastatin and Rosuvastatin

The choice between atorvastatin and rosuvastatin should consider the degree of cholesterol lowering needed, cost considerations, individual patient response, and potential drug interactions (atorvastatin has more significant interactions with certain medications) 3, 4.

  • Both medications are taken once daily, preferably at the same time each day.
  • Side effects are similar for both and include muscle pain, liver enzyme elevations, and rarely rhabdomyolysis.

Monitoring and Follow-up

Regular monitoring of lipid levels and liver function is recommended with either medication, as stated in the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 2.

From the FDA Drug Label

Rosuvastatin was compared with the statins (atorvastatin, simvastatin, and pravastatin) in a multicenter, open-label, dose-ranging study of 2,240 patients with hyperlipidemia or mixed dyslipidemia. 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 In a study of adult patients with HeFH (baseline mean LDL of 291 mg/dL), patients were randomized to rosuvastatin 20 mg or atorvastatin 20 mg. Table 12: LDL-C Percent Change from Baseline 1LS Means are least square means adjusted for baseline LDL-C Rosuvastatin (n=435) LS Mean 1(95%CI) Atorvastatin (n=187) LS Mean 1(95% CI) Week 620 mg-47% (-49%, -46%)-38% (-40%, -36%)

The comparison between Atorvastatin (Lipitor) and Rosuvastatin (Crestor) shows that:

  • Rosuvastatin reduces LDL-C more than Atorvastatin at doses of 10 mg, 20 mg, and 40 mg.
  • In a study of adult patients with HeFH, Rosuvastatin 20 mg reduced LDL-C by 47% compared to Atorvastatin 20 mg which reduced LDL-C by 38%.
  • The study results suggest that Rosuvastatin may be more effective in reducing LDL-C levels compared to Atorvastatin 5.
  • Key points of comparison include:
    • LDL-C reduction: Rosuvastatin reduces LDL-C more than Atorvastatin.
    • Dose comparison: Rosuvastatin 10 mg, 20 mg, and 40 mg reduce LDL-C more than corresponding doses of Atorvastatin.
    • HeFH study: Rosuvastatin 20 mg reduces LDL-C more than Atorvastatin 20 mg in adult patients with HeFH.

From the Research

Comparison of Atorvastatin and Rosuvastatin

  • Atorvastatin and Rosuvastatin are both statins used to lower LDL cholesterol levels in patients with hypercholesterolemia.
  • A study comparing the efficacy and safety of rosuvastatin 40 mg and atorvastatin 80 mg in high-risk patients with hypercholesterolemia found that rosuvastatin reduced LDL-C levels significantly more than atorvastatin at 8 weeks [-56% versus -52%, p<0.001] [6].
  • Another study found that adding ezetimibe to atorvastatin 10 mg reduced LDL-C levels significantly more than doubling atorvastatin to 20 mg or switching to rosuvastatin 10 mg [22.2% vs 9.5% or 13.0%, respectively, p <0.001] [7].
  • Rosuvastatin, alone or in combination with ezetimibe, provides intensive LDL-C reductions (up to 50-55% and 60-75%, respectively) with a low risk of side effects and in an efficient manner, in patients both without and with established atherosclerotic vascular disease 8.
  • The addition of ezetimibe to ongoing simvastatin, atorvastatin, or rosuvastatin monotherapy offers greater reduction in LDL-C among patients at high risk of cardiovascular disease compared to doubling the initial statin dose 9.

Efficacy and Safety

  • Both atorvastatin and rosuvastatin are well-tolerated treatments for hypercholesterolemia.
  • Rosuvastatin has been shown to have a low risk of adverse effects and drug-drug interactions, and has proven benefits in the prevention of cardiovascular disease 10.
  • The combination of rosuvastatin and ezetimibe has been shown to enable considerable reductions in LDL-C (up to 60-75%) with a good safety profile in a broad spectrum of patients with hypercholesterolemia 10.

Treatment Outcomes

  • Rosuvastatin may improve LDL-C goal achievement in high-risk patients with hypercholesterolemia compared to atorvastatin 6.
  • The addition of ezetimibe to atorvastatin has been shown to produce significantly greater improvements in key lipid parameters and significantly greater attainment of LDL-C treatment targets than doubling atorvastatin or switching to (or doubling) rosuvastatin 7.

References

9
Research

Ezetimibe in high-risk, previously treated statin patients: a systematic review and network meta-analysis of lipid efficacy.

Clinical research in cardiology : official journal of the German Cardiac Society, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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