Are we sure that rosuvastatin is the safest them all? Is there any multicenter research trials to say that the differences among the statins are significant?

Also price of the drug and the availability might be the reason of high prescription of atorvastatin in some countries.

not at all, here we can't use the term safest, it's just preferable than other. With all the clinical trials and studies always go for rosuvastatin as safer than atorvastatin.

Pfizer invested more in the marketing of atorvastatin than the maker of rosuvastatin...

First agents are always the safest compared to later developed ones which are usually forced to produce by scientist and are always more potent which means more discomfort, more complication, more side effects and more unknown ...... This comment is valid for ARB s statins etc. Usually modest medication provide desired preventive effect and always safer for the patients lets dont be slaves of industry

In the UK, an important factor is price in the GP's mind! Rosuvastatin is far more expensive than simvastation or atovastatin. Advantage of rosuvastatin is that it lowers lipids in doses as low as 5mg/day and equally important is that it has been shown to prolong life in patients with normal lipid profile and to inhibit inflammation (CRP). Rosuvastatin appears to be better tolerated by patients, although its long term side effects need to be monitored. Recent evidence suggest chronic use of some of the statins predisposes patients to diabetes, however, not taking statins for CVD patients equates to reduced life expectancy. Lets see what benefits PCSK9 inhibitors brings!

http://www.ncbi.nlm.nih.gov/pubmed/24958078

Dear Jorge Ramirez, thank you for your response. I've seen your provided papers. None of those were unable to state about significant adverse effects of rosuvastatin that is higher than other statins.

And my supporting research papers are given here, please check those recent studies. Thanks.

http://www.ncbi.nlm.nih.gov/pubmed/24008003

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481024/

http://www.ncbi.nlm.nih.gov/pubmed/23637557

http://www.ncbi.nlm.nih.gov/pubmed/23476802

Yeah...all stanins shows side effects, we should chose the optimum drug therapy. In recent studies, Rosuvastatin shows lesser adverse effects than Atorvastatin and suggested to use in diabetic patients as it is less prone to DM than Atorvastatin.

Here a paper on patient compliance is attached.

In USA, Atorvastatin is considerably cheaper than Rosuvastatin and in some managed care systems (HMO in its various variations) even when a patient was on Rosuvastatin, decisions were made for monetary reasons that forced the patients to switch to Atorvastatin, unless they were willing to pay the entire cost for Rosuvastatin on their own. Only exceptions are where a physician can convince the insurance that use of Rosuvastatin is necessary, which is usually difficult. If an individual does have adverse side effects to Atorvastatin and not to Rosuvastatin, that would be a different situation.

I imagine that on the end of prescribing physicians, they too must have some pressure/motivation to opt of cheaper alternatives if difference in safety/efficiacy is marginal.

Dear Arjyabrata,

you should also consider that atorvastatin beats rosuvastatin for protecting kidneys in diabetic and nondiabetic patients.

http://www.medscape.com/viewarticle/790656

Pfizer has invested heavily in promotion. At this time also, in many country atorvastatin has missed the brand and it has become generic, they are cheaper.

In Australia, the first medicines dispensed is still atorvastation followed by rosuvastatin.

Refer p17

http://www.pbs.gov.au/statistics/2012-2013-files/expenditure-and-prescriptions-12-months-to-30-06-2013.pdf

Dear Jorge Ramirez,

yes of course, rosuvastatin has side effects, I wouldn't ignore that, but we have to make better treatment in case of emergency situations whereas we have to analyze risk-benefit ratio first.

Thanks.

Dear, Jorge Ramirez

First of all thanks for your patience study interest in this very important topic of current medical treatment. Every point you dragged out is logical enough.

I want to share some related information here about the current treatment pattern of Bangladesh. In Bangladesh the treatment system is different than the developed world, here people need to recover quickly as possible, the simple demand the stand on the physician. That's why rosuvastatin is more common now-a-days in our local market and prescription is made often.

"Data shows that rosuvastatin did not reduce cardiovascular events or deaths in comparison with a placebo."

The above seems to be story of "cholesterol is bad" syndrome so let's design and throw the strongest inhibitors of HMG-CoA reductase at it... the bandwagon on which our entire healthcare system jumped on with, as it turns out, less than thoroughly studies plan of action. When cholesterol got labeled as all bad, fulfillment of our caloric requirements almost abruptly shifted more towards consumption of carbohydrates and obesity became prevalent. I realize that this is a very short and simplified version but rather than advocating moderation and be guided by long-term effects of our dietary habits, we tend to let things go into crisis mode and then try to fix the problems. There are, of course, a few practical advantages in this modality. A dying person is willing to pay far more and is usually quite satisfied with less than perfect outcome. It seems that this mentality must be getting common in not so wealthy societies, such as Bangladesh, which his unfortunate.

Jorge Ramirez,

the data of research article is a different issue trial against placebo, here rosuvastatin shows insignificant activity over cvs.

But we got many patients having high cholesterol level along with hypertension and diabetes. Many of them have severe cardiac problems too, even asthma is almost a common issue. Here we have to select a balanced therapy to maintain and regulate all of the complications s/he has, e.g. antihypertensives+lipid lowering agents+antidiabatics. It's been really a challenge for us to control them! In few cases we need to trigger any one of those therapy to reduce the major complication. All along it's a supper critical situation at all. You will wonder that almost 40% CVD patients in Bangladesh having high level of LDLs.

Tausif Alam,

that's the point, exactly what I intended to overlap. When the optimum goal of treatment is to support the patient to live, many theoretical assessments get blurred!

Thanks.

Dear Jorge Ramirez,

Yes of course, the JUPITER trial of originator brand Crestor shows insignificant evidence of reduction in CVD i.e. morbidity and mortality compared to placebo in clinical trial phase III.

Though nobody could assure to minimize the mortality in cardiovascular events with a single lipid lowering agent therapy, that isn't the therapeutics directed. It can only be used to reduce the cardiovascular risks by virtue of all lipid lowering agent.

And the main theme of mine on which I'm trying to attain the attention in the treatment of type-II diabetes associated hypertension. I do believe, here it will show good effects as we observed from some local patients, their compliance is high enough to hold attention towards rosuvastatin rather than atorvastatin in that case.

Thanks with regards,

Arjya

Dear Ramirez,

all of the articles and the resources drive to opposite side of me.

Whatever, to overcome all the problems here a treatment plan is given:

Metformin 750mg XR + Rosuvastatin 20 mg + Bisoprolol Hemifumarate 10 mg

once daily.

It works.

To be fair to followers of other regimens, I highly doubt that anyone treats their patients with a notion that their method doesn't work!  ;)

haha...little bit joke indeed :P

please check it out....it covers all of my sense :)

Rosuvastatin A Review of the Pharmacology and Clinical

Effectiveness in Cardiovascular Disease

if rosuvastatin is priced more affordable to the patients, there will be more usage

Dear Kuan Leong Yew

of course that is a factor for less prescription, and you know all superior molecules having a higher costs for API.

 can you tell me what is the benefits of rosuvastatin on renal failure 

Atorvastatin was the safest statin in relation to renal function.

Concerning the statin diabetes risk. all statins are not the same, We need to Individualize patient care. For patients needing a statin and at risk of new-onset diabetes, or patients with diabetes/metabolic syndrome, consider pitavastatin with Cardiovascular benefit and lower risk of diabetes

Based on the meta-analyses evaluating the effects of statins on the incidence of diabetes, statins are associated with a small increase in the risk of diabetes with an estimated NNH of 255 patients over four years. The evidence suggests no difference in risk among agents.

Data from three non-randomized studies suggest similar rates of adverse events with rosuvastatin compared to other statins including acute renal failure, cataract, liver dysfunction, and myopathy.