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ESC 23: LODESTAR: Rosuvastatin Vs Atorvastatin Treatment For CAD Patients
Published: 25 Aug 2023
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ESC 23 — Dr Myeong-Ki Hong (Yonsei University College of Medicine, KR) outlines the late-breaking results from the LODESTAR trial (NCT02579499).
LODESTAR (Yonsei University) was a randomized, open-label multicenter trial that aimed to compare the clinical efficacy and safety of atorvastatin vs rosuvastatin for the secondary prevention of coronary artery disease. 4400 coronary artery disease patients were enrolled in the trial and were randomized to receive either high-potent statin therapy or LDL-C goal statin therapy.
Previously, no data had compared results in patients treated with atorvastatin to those who had been treated with rosuvastatin. Results suggest that clinical outcomes were similar between both groups of patients. Rates of LDL-C were significantly lower in the rosuvastatin group, but this drug also carried a higher risk of new-onset diabetes compared to atorvastatin treatment.
Questions:
- What is the importance of this study?
- What do the current guidelines, specifically the 2013 ACC/AHA guideline recommend?
- What was the study design and the baseline characteristics of the patients?
- What were the key findings presented at ESC?
- What are the benefits of the treat-to-target strategy?
- What are take-home messages for patient care?
- How should these results influence guidelines?
Recorded on-site at ESC Congress 2023, Amsterdam.
For more content from ESC Congress 2023 head to the Hot Line & Late-breaking Science Video Collection.
Editors: Mirjam Boros and Jordan Rance
Video Specialists: Dan Brent, Tom Green, Mike Knight, Oliver Miles
"I'm Professor Hong. I'm working as an active interventionalist in the Severance hospital located in Seoul, Korea.
Importance of this study
As a physician, we know that the statin is very important, the most popular two statins for the patient with atherosclerosis or coronary artery disease. The most popular one is atorvastatin and the second one is rosuvastatin. Many of the physicians want to know about which one is better. But there is no randomised comparison between two potent statin drugs. There is no specific guideline.
What the Guidelines, Specifically the 2013 ACC/AHA Guidelines, Reccomend
Just use the high-intensity statin with the target LDL cholesterol level less than 55 or 50% reduction in the very high-risk patient. Strongly recommended the high-intensity statin with atherosclerotic cardiovascular disease.
Study Design and Baseline Characteristics
The baseline characteristics were similar. There was no statistical difference out of baseline characteristics of atorvastatin-treated patient or rosuvastatin-treated patient. This study design is the randomised open-level multicenter study, and the statin was randomly assigned in both group and the number of study population is 4400 patients, half of it the atorvastatin half of it the rosuvastatin as I mentioned.
Key Results
Still there is no randomised clinical data to compare the rosuvastatin versus the atorvastatin-treated patient anyhow, the result of my study is that the three-year clinical outcome was similar between two groups. And the second finding is that the cholesterol, LDL cholesterol level is significantly lower in the rosuvastatin. However, the rosuvastatin treatment is associated with more the risk of the onset of new onset diabetes and catheter operation.
Benefits of the Treat-to target Strategy
The treat to target this strategy is, a something new strategy. What I mean is that the current guideline is high-intensity statin treatment? That is the only way to treat the target strategy maybe one of the alternatives in some specific patients.
Take-Home Messages
First, to comparing the two potent statin atorvastatin or rosuvastatin is comparable. So anyhow, this is the first data to compare the two statin drugs, and the second one is the treat-to-target strategy may be a good alternative in patients with coronary artery disease instead of the high-intensity statin.
How these Results Should Influence Guidelines
I'm not sure anyhow, this is the beginning, beginning we need to accumulate more data, and this is the beginning so the other study accumulated more and more and then that time I think there's a guideline may be changed."
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