Differences Between Lipitor (Atorvastatin) and Crestor (Rosuvastatin)
Rosuvastatin (Crestor) is more potent than atorvastatin (Lipitor) on a milligram-per-milligram basis, providing greater LDL-C reduction at comparable doses while maintaining a similar safety profile. 1
Potency and Efficacy Comparison
- Rosuvastatin provides greater LDL-C reduction than atorvastatin at comparable doses: 10mg rosuvastatin reduces LDL-C by approximately 45% versus 39% with 10mg atorvastatin 1
- At maximal doses, rosuvastatin 40mg is more effective than atorvastatin 80mg in lowering direct LDL cholesterol (52% vs 50%) and small dense LDL cholesterol (53% vs 46%) 2
- Rosuvastatin has been shown to be more effective in increasing HDL cholesterol levels compared to atorvastatin at equivalent doses 3
- In long-term studies (52 weeks), rosuvastatin 10mg produced greater LDL-C reductions than atorvastatin 10mg (47% vs 44%) 4
Intensity Classification
- According to the American College of Cardiology/American Heart Association guidelines, high-intensity statin therapy (≥50% LDL-C reduction) includes atorvastatin 40-80mg and rosuvastatin 20-40mg 5
- Moderate-intensity statin therapy (30-49% LDL-C reduction) includes atorvastatin 10-20mg and rosuvastatin 5-10mg 5
- The following table shows the intensity classification of both statins 5:
| Intensity | LDL-C Lowering | Atorvastatin Doses | Rosuvastatin Doses |
|---|---|---|---|
| High | ≥50% | 40-80mg | 20-40mg |
| Moderate | 30-49% | 10-20mg | 5-10mg |
Safety and Side Effect Profile
- Both medications have similar safety profiles with comparable risks of myalgia, liver enzyme elevations, and other adverse events 6
- Risk factors for statin-related side effects with both medications include female gender, advanced age, Asian descent, and uncontrolled hypothyroidism 1, 7
- Rosuvastatin has a longer half-life (19 hours) compared to atorvastatin (14 hours), which may affect dosing frequency and duration of potential side effects 1
- Both statins may cause muscle problems, including muscle pain, tenderness, or weakness, which can rarely lead to serious conditions like rhabdomyolysis 8, 7
Metabolism and Drug Interactions
- Atorvastatin is primarily metabolized by CYP3A4, while rosuvastatin relies more on CYP2C9, which may result in different drug interaction profiles 1
- Patients taking medications that inhibit these enzyme systems may experience different side effect profiles with each statin 1
- Due to different metabolic pathways, switching between these statins may be beneficial for patients experiencing side effects 1
Clinical Applications and Goal Attainment
- More patients achieve their LDL-C goals with rosuvastatin compared to equivalent doses of atorvastatin 4, 9
- In one study, 82% of patients treated with rosuvastatin 10mg achieved their LDL-C goal without dose titration, compared with 59% of patients treated with atorvastatin 10mg 4
- For high-risk patients requiring intensive LDL-C lowering (≥50%), rosuvastatin 20-40mg or atorvastatin 40-80mg are recommended 5, 1
- When maximum statin therapy is insufficient to reach LDL-C goals, combination with ezetimibe is recommended before considering PCSK9 inhibitors 1
Effects on HDL Subpopulations
- Both statins increase large alpha-1 and alpha-2 HDL particles and decrease small pre-beta-1 HDL levels 3
- Rosuvastatin produces significantly greater increases in alpha-1 (24% vs 12%) and alpha-2 (13% vs 4%) HDL particles compared to atorvastatin 3
- In patients with low HDL cholesterol, rosuvastatin's effect on increasing beneficial HDL subpopulations is even more pronounced 3
When choosing between these statins, consider the patient's LDL-C reduction needs, potential drug interactions, and cost factors, with rosuvastatin generally offering greater potency but potentially at a higher cost.