What statin (HMG-CoA reductase inhibitor) raises high-density lipoprotein (HDL) and lowers low-density lipoprotein (LDL) along with triglycerides?

From the Guidelines

Rosuvastatin is the statin that most effectively raises HDL cholesterol while lowering both LDL cholesterol and triglycerides, as evidenced by its superior efficacy in improving overall lipid profiles compared to other statins 1.

Key Points to Consider

• The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol recommends rosuvastatin as a high-intensity statin therapy option, with a dosage of 20 mg (40 mg) 1.
• Rosuvastatin has demonstrated a significant reduction in major cardiovascular events in randomized controlled trials (RCTs), with a median reduction in LDL-C from the VOYAGER database 1.
• The medication works by inhibiting HMG-CoA reductase, an enzyme crucial for cholesterol production in the liver, which not only reduces LDL and triglyceride levels but also promotes HDL production.
• Potential side effects of rosuvastatin include muscle pain, liver enzyme elevations, and rarely, memory problems, so regular monitoring with a healthcare provider is essential.

Dosage and Administration

• Rosuvastatin is typically prescribed at doses ranging from 5 to 40 mg once daily.
• It is essential to maintain a heart-healthy diet and regular exercise to maximize the benefits of rosuvastatin.

Comparison with Other Statins

• Rosuvastatin has a unique chemical structure that allows it to bind more strongly to the HMG-CoA reductase enzyme and have greater liver selectivity than other statins, explaining its enhanced ability to improve multiple lipid parameters simultaneously 1.
• Other statins, such as atorvastatin and simvastatin, may also be effective in lowering LDL cholesterol and triglycerides, but rosuvastatin has demonstrated superior efficacy in raising HDL cholesterol and improving overall lipid profiles.

From the FDA Drug Label

Rosuvastatin reduces Total-C, LDL-C, ApoB, non-HDL-C, and TG, and increases HDL-C, in adult patients with hyperlipidemia and mixed dyslipidemia At one year, rosuvastatin increased HDL-C and reduced LDL-C, hsCRP, total cholesterol and serum triglyceride levels (p<0. 001 for all versus placebo). Table 10: Lipid-modifying Effect of Rosuvastatin in Adult Patients with Hyperlipidemia (Adjusted Mean % Change from Baseline at Week 6) DoseNTotal-CLDL-CNon-HDL-CApoBTGHDL-C Placebo13-5-7-7-3-33 Rosuvastatin 5 mg17-33-45-44-38-3513 Rosuvastatin 10 mg17-36-52-48-42-1014 Rosuvastatin 20 mg17-40-55-51-46-238 Rosuvastatin 40 mg18-46-63-60-54-2810

The statin that raises HDL and lowers LDL along with triglycerides is rosuvastatin 2.

• Rosuvastatin has been shown to increase HDL-C and reduce LDL-C, total cholesterol, and serum triglyceride levels.
• The lipid-modifying effects of rosuvastatin are dose-dependent, with higher doses resulting in greater reductions in LDL-C and triglycerides, and greater increases in HDL-C.

From the Research

Statin Effects on HDL, LDL, and Triglycerides

• Rosuvastatin has been shown to increase levels of high-density lipoprotein cholesterol (HDL-C) and reduce levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides in patients with hyperlipidemia 3, 4, 5, 6, 7.
• Studies have demonstrated that rosuvastatin is more effective in raising HDL-C levels compared to other statins, such as atorvastatin 5, 7.
• Rosuvastatin has been found to reduce LDL-C by 43% to 63% and increase HDL-C by approximately 10% 3.
• The lipid-lowering efficacy of rosuvastatin is dose-dependent, with higher doses resulting in greater reductions in LDL-C and non-HDL-C 6.
• Rosuvastatin has been shown to be well-tolerated and safe, with a similar safety profile to other statins 3, 4, 7.

Comparison to Other Statins

• Rosuvastatin has been compared to atorvastatin in several studies, with results showing that rosuvastatin is more effective in reducing LDL-C and increasing HDL-C 5, 7.
• Rosuvastatin has been found to be approximately three-fold more potent than atorvastatin in reducing LDL-C 6.
• Both rosuvastatin and atorvastatin have been shown to be effective in reducing triglycerides, but rosuvastatin may be more effective in this regard 7.

Clinical Implications

• Rosuvastatin may be a valuable treatment option for patients with hyperlipidemia, particularly those who require significant reductions in LDL-C and increases in HDL-C 3, 4.
• The use of high-dose rosuvastatin (40 mg/day) may be effective in reducing cardiovascular risk in patients with high or very high cardiovascular risk 7.