What is the difference between atorvastatin (Lipitor) and rosuvastatin (Crestor), and what are their typical doses for treating high cholesterol?

Atorvastatin aur Rosuvastatin: Upyog aur Antar

Kab dete hain (Indications)

Dono statins high cholesterol aur cardiovascular disease ke risk ko kam karne ke liye diye jate hain, lekin unki potency aur doses mein farak hai. 1

Primary Prevention (Pehli baar heart disease se bachne ke liye):

• 40-75 saal ke diabetes patients ko moderate-intensity statin therapy di jati hai 1
• High cardiovascular risk wale patients (ek ya zyada risk factors ke sath) ko high-intensity statin therapy di jati hai, taaki LDL cholesterol baseline se ≥50% kam ho aur <70 mg/dL tak pahunch jaye 1
• LDL cholesterol ≥190 mg/dL wale patients ko high-intensity statin zaroor deni chahiye 2

Secondary Prevention (Pehle se heart disease hai):

• ≤75 saal ke patients jo pehle se heart attack, stroke, ya arterial disease se suffer kar chuke hain unko high-intensity statin therapy deni chahiye 1, 2
• >75 saal ke patients ko moderate-intensity statin consider karni chahiye 1

Dono mein mukhya antar (Key Differences)

Potency (Taqat):

Rosuvastatin milligram-per-milligram basis par atorvastatin se zyada powerful hai 3, 4:

• Rosuvastatin 10 mg LDL-C ko approximately 45% kam karta hai 3, 4
• Atorvastatin 10 mg LDL-C ko approximately 39% kam karta hai 1, 4

Maximum doses par comparison:

• Rosuvastatin 40 mg LDL-C ko 63% tak kam kar sakta hai 4
• Atorvastatin 80 mg LDL-C ko 51% tak kam kar sakta hai 4
• Clinical studies mein rosuvastatin 40 mg ne atorvastatin 80 mg se behtar LDL-C reduction dikhaya (60% vs 52%) 5, 6

Metabolism aur Drug Interactions:

• Atorvastatin primarily CYP3A4 enzyme se metabolize hota hai 3
• Rosuvastatin primarily CYP2C9 enzyme par depend karta hai 3
• Rosuvastatin ka half-life zyada lamba hai (19 hours) compared to atorvastatin (14 hours) 3

Doses (Kharake)

Moderate-Intensity Therapy (30-49% LDL-C reduction):

• Atorvastatin: 10-20 mg daily 1
• Rosuvastatin: 5-10 mg daily 1

High-Intensity Therapy (≥50% LDL-C reduction):

• Atorvastatin: 40-80 mg daily 1
• Rosuvastatin: 20-40 mg daily 1

Practical Dosing Strategy:

High-risk patients ke liye starting dose:

• Rosuvastatin 20 mg ya atorvastatin 40-80 mg se shuru karein 1, 2
• Agar target LDL (<70 mg/dL) achieve nahi hota, toh dose badhayein ya ezetimibe add karein 1

Moderate-risk patients ke liye:

• Rosuvastatin 5-10 mg ya atorvastatin 10-20 mg se shuru karein 1

Important Clinical Considerations

Goal Achievement:

Rosuvastatin se zyada patients apne LDL-C goals achieve karte hain compared to equivalent doses of atorvastatin 7, 8:

• Rosuvastatin 10 mg se 68.8% patients ne NCEP ATP III goal achieve kiya 8
• Atorvastatin 20 mg se 62.5% patients ne goal achieve kiya 8

Tolerability aur Safety:

• Dono statins generally well-tolerated hain 3, 6
• Muscle symptoms (SAMS) dono ke sath ho sakti hain, lekin true complete intolerance rare hai 3
• Rosuvastatin 40 mg ki tolerability atorvastatin 80 mg se thodi behtar ho sakti hai 6

Common Pitfalls:

• Low doses par ruk jana: Bahut se patients ko adequate doses nahi milte, isliye target LDL achieve nahi hota 7
• Dose titration na karna: Agar 6-8 weeks mein goal achieve nahi hota, toh dose badhana chahiye 1
• Drug interactions ignore karna: CYP3A4 inhibitors (jaise macrolide antibiotics, azole antifungals) atorvastatin ke sath zyada interaction karte hain 3

Special Populations:

• Elderly patients (>75 years): Moderate-intensity therapy prefer karein, lekin high-intensity bhi consider kar sakte hain agar patient healthy hai 1
• Diabetes patients: High-intensity therapy strongly recommended hai agar additional risk factors hain 1, 2
• Asian descent patients: Lower starting doses consider karein kyunki increased drug levels ho sakte hain 3