Rosuvastatin versus atorvastatin in achieving lipid goals in patients at high risk for cardiovascular disease in clinical practice: A randomized, open-label, parallel-group, multicenter study (DISCOVERY Alpha study)

摘要

The majority of clinical trials investigating the clinical benefits of lipid-lowering therapies (LLTs) have focused on North American or western and nothern European populations. Therefore, it is timely to confirm the efficacy of these agents in other patient populations in routine clinical practice.The aim of the Direct Statin COmparison of low-density lipoprotein cholesterol (LDL-C) Values:an Evaluation of Rosuvastatin therapY (DISCOVERY) Alpha study was to compare the effects of rosuvastatin 10 mg with those of atorvastatin 10 mg in achieving LDL-C goals in the Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice guidelines.This randomized, open-label,parallel-group study was conducted at 93 centers in eastern Europe (Estonia,Latvia,Romania,Russia,Slovenia), Central and South America (Chile,Dominican Republic,El Salvador,Guatemala,Honduras,Nicaragua, Panama),and the Middle East (Israel,Kuwait,Saudi Arabia,United Arab Emirates). Male and female patients aged ≥18 years with primary hypercholesterolemia (LDL-C level,>135 mg/dL if LLT-naive or ≥120 mg/dL if switching statins;triglyceride [TG] level, <400 mg/dL) and a 10-year coronary heart disease (CHD) risk >20% or a history of CHD or other established atherosclerotic disease were eligible for inclusion in the study.Patients were randomly assigned to receive rosuvastatin 10-mg or atorvastatin 10-mg tablets QD for 12 weeks.No formal statistical analyses or comparisons were performed on lipid changes between switched and LLT-naive patients because of the different lipid inclusion criteria for these patients. The primary end point was the proportion of patients achieving 1998 European LDL-C goals after 12 weeks of treatment. A subanalysis was performed to assess the effects of statins in patients who had received previous statin treatment versus those who were LLT-naive.Tolerability was assessed using laboratory analysis and direct questioning of the patients.A total of 1506 patients (52.1% women, 47.9% men; mean [SD] age, 58.2 [10.8] years) participated in the study (rosuvastatin, 1002 patients; atorvastatin, 504 patients; previous LLT, 567 patients). A significantly higher proportion of patients achieved 1998 European LDL-C goals after 12 weeks with rosuvastatin 10 mg than with atorvastatin 10 mg (72.5% vs 56.6%; P < 0.001). Similarly, more patients achieved the 2003 European LDL-C goals with rosuvastatin 10 mg compared with atorvastatin 10 mg (57.5% vs 39.2%). Rosuvastatin 10 mg was associated with a significantly greater change in LDL-C levels compared with atorvastatin 10 mg, in patients who were LLT-naive (LDL-C: 44.7% vs 33.9%; P < 0.001) and in patients who had received previous LLT (LDL-C: ?32.0% vs ?26.5%; P=0.006). TG levels were also decreased with rosuvastatin 10 mg and atorvastatin 10 mg, although there was no significant difference between treatments.Similarly,there was no significant difference in the increase in high-density lipoprotein cholesterol levels between treatments.The most common adverse events overall were headache 16/1497 (1.1%), myalgia 10/1497 (0.7%),and nausea 10/1497 (0.7%).In this study in patients with primary hypercholesterolemia in clinical practice, greater reductions in LDL-C levels were achieved with a starting dose (10 mg) of rosuvastatin compared with atorvastatin 10mg,with more patients achieving European LDL-C goals. Both treatments were well tolerated.