Is the maximum dose of rosuvastatin (Crestor) effective in preventing strokes?

From the Guidelines

Rosuvastatin at its maximum dose (20mg daily, not 40mg) is recommended for preventing strokes in high-risk individuals, particularly those with high cholesterol or a history of cardiovascular disease, as it provides a potent cholesterol-lowering effect and has anti-inflammatory effects that help stabilize arterial plaques. This medication works by reducing LDL ("bad") cholesterol, making them less likely to rupture and cause strokes. According to the 2024 recommendations on the optimal use of lipid-lowering therapy in established atherosclerotic cardiovascular disease and following acute coronary syndromes: a position paper of the international lipid expert panel (ilep) 1, the goal is to achieve target LDL-C values of < 55 mg/dL (< 1.4 mmol/L), which can be achieved by taking the highest possible doses of potent statins, such as rosuvastatin, as long as they are well tolerated.

The appropriate dose should be determined by your doctor based on your specific risk factors, cholesterol levels, and tolerance to the medication. Many patients achieve sufficient benefits at lower doses (10-20mg daily). If prescribed the maximum dose, regular monitoring of liver function and muscle symptoms is important. Additionally, rosuvastatin should be taken as part of a comprehensive approach to stroke prevention that includes:

• Blood pressure control
• Not smoking
• Regular physical activity
• A heart-healthy diet As stated in the 2013 acc/aha guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults 1, high-intensity statin therapy, such as rosuvastatin 20 mg daily, reduces ASCVD events more than moderate-intensity statin therapy in individuals with clinical ASCVD.

It is essential to note that the maximum dose of rosuvastatin is 20mg daily, not 40mg, as stated in the guidelines 1. The use of statin therapy should be individualized, especially in older adults, and the potential for an ASCVD risk-reduction benefit and the potential for adverse effects, drug–drug interactions, and patient preferences should be considered.

From the FDA Drug Label

Rosuvastatin significantly reduced the risk of nonfatal myocardial infarction, nonfatal stroke, and arterial revascularization procedures. Rosuvastatin significantly reduced the risk of myocardial infarction (6 fatal events and 62 nonfatal events in placebo-treated subjects vs. 9 fatal events and 22 nonfatal events in rosuvastatin-treated subjects) and the risk of stroke (6 fatal events and 58 nonfatal events in placebo-treated subjects vs. 3 fatal events and 30 nonfatal events in rosuvastatin-treated subjects)

The maximum dose of rosuvastatin is 40 mg, and it has been shown to reduce the risk of nonfatal stroke. However, the label does not explicitly state that the maximum dose is the best option for preventing strokes.

• The study results show that rosuvastatin 20 mg also reduced the risk of stroke.
• The label does not provide a direct comparison of the efficacy of different doses of rosuvastatin in preventing strokes. 2

From the Research

Rosuvastatin Max Dose for Stroke Prevention

• The maximum dose of rosuvastatin is 40 mg per day, but its effectiveness in preventing strokes is still a topic of research 3, 4, 5, 6, 7.
• A study published in the Journal of Stroke found that moderate-intensity rosuvastatin plus ezetimibe was superior to high-intensity rosuvastatin alone for intensive LDL-C reduction in patients with recent ischemic stroke 3.
• Another study published in the International Journal of Stroke found that intensive statin treatment, including high-dose rosuvastatin, can reduce the risk of cardiovascular events in patients with ischemic stroke 4.
• The efficacy and safety of rosuvastatin 40 mg in patients with severe hypercholesterolemia was assessed in a study published in the American Journal of Cardiology, which found that long-term treatment with rosuvastatin 40 mg is safe and effective in reducing LDL cholesterol levels 5.
• A meta-analysis published in Atherosclerosis found that high-intensity statins, including rosuvastatin 20-40 mg, can reduce LDL cholesterol levels by ≥50% in patients with atherosclerotic cardiovascular disease, diabetes, or a 10-year ASCVD risk ≥7.5% 6.
• An observational study published in the Indian Heart Journal found that intensive therapy with rosuvastatin 40 mg/day can significantly reduce LDL cholesterol levels and other lipid parameters in high-risk patients with acute coronary syndrome 7.

Key Findings

• Rosuvastatin 40 mg can reduce LDL cholesterol levels by ≥50% in patients with high cardiovascular risk 3, 6, 7.
• Moderate-intensity rosuvastatin plus ezetimibe may be more effective than high-intensity rosuvastatin alone in reducing LDL cholesterol levels in patients with recent ischemic stroke 3.
• Intensive statin treatment, including high-dose rosuvastatin, can reduce the risk of cardiovascular events in patients with ischemic stroke 4.
• Rosuvastatin 40 mg is safe and effective in reducing LDL cholesterol levels in patients with severe hypercholesterolemia 5.