Atorvastatin and rosuvastatin have similar lipid-lowering effects. What are the differences in their use?

Statins are commonly used drugs for the treatment of hyperlipidemia and atherosclerosis. Among these drugs, atorvastatin and rosuvastatin, as "powerful statins", are relatively widely used. Many people have asked Huazi, when treating hyperlipidemia or stabilizing arterial plaques to prevent thrombosis, what is the difference between atorvastatin and rosuvastatin, and which one is more suitable for you?

1. Two types of "potent statins" Statins include lovastatin, simvastatin, pravastatin, fluvastatin, pitavastatin, atorvastatin and rosuvastatin. Different statins reduce low-density lipoprotein cholesterol (LDL-C) to different degrees. Only atorvastatin and rosuvastatin can reduce LDL-C levels by more than 50%, so they are called "potent statins."

Why do doctors pay so much attention to LDL-C levels? Because LDL-C is closely related to the risk of cardiovascular and cerebrovascular diseases. The formation of atherosclerosis is the result of LDL-C entering the arterial intima. As long as the level of LDL-C is lowered, it can be prevented from entering the blood vessel intima.

For healthy people, LDL-C values ​​below 3.37mmol/L are normal. However, if you have one of the "three highs" such as high blood pressure, diabetes, and high blood lipids, or "two highs", you should lower your LDL-C to below 2.6mmol/L; if you have all three highs, it is best to lower your LDL-C to below 2.0mmol/L; if you have already suffered from myocardial infarction, cerebral infarction, limb arterial thrombosis and other diseases, you should lower your LDL-C to below 1.8mmol/L.

But many people's initial LDL-C level is very high, which may reach more than 4 points, or more than 5. If you want to make it reach the standard, you need to choose atorvastatin or rosuvastatin to achieve the effect of "cutting it in half".

2. How to choose between the two is related to liver and kidney function. Atorvastatin and rosuvastatin have the same lipid-lowering strength, the difference is the dosage. The dosage of atorvastatin is twice that of rosuvastatin. For example, 10 mg of atorvastatin is the same as 5 mg of rosuvastatin; 20 mg of atorvastatin is the same as 10 mg of rosuvastatin. The maximum dose of atorvastatin is 80 mg per day, and the maximum dose of rosuvastatin is 40 mg per day.

However, the two have different metabolic pathways. Atorvastatin is metabolized in the liver, and its metabolites have lipid-lowering activity; while rosuvastatin is metabolized through the liver and kidney dual channels, and its metabolites have no lipid-lowering activity. Therefore, people with normal liver function but impaired kidney function are suitable for atorvastatin, while people with normal kidney function but impaired liver function are suitable for rosuvastatin.

Clinical trials have shown that the side effects of atorvastatin are significantly lower than those of rosuvastatin. Therefore, when statins are used alone for treatment, atorvastatin is usually used to reduce the incidence of side effects.

In terms of drug interactions, most commonly used drugs (such as antihypertensive drugs, antibiotics, antianxiety drugs, etc.) need to be metabolized by the liver, and will compete with atorvastatin for the same liver drug enzymes, which will cause atorvastatin accumulation poisoning and liver damage. Therefore, when multiple drugs are used in combination, it is more appropriate to use rosuvastatin.

3. High-dose statins are not recommended. Although atorvastatin and rosuvastatin are both "powerful statins" that can reduce LDL-C levels by more than 50%, it is not recommended to increase the dose of the drug when low- to medium-dose drugs cannot bring LDL-C to the target. This is because the efficacy of statins is not "doubled" with their dose.

Regardless of the type of statin, doubling the dose can only reduce LDL-C by 6%, but the probability of side effects increases significantly. It is now generally recognized that the safer approach is to use low- to medium-dose statins in combination with the cholesterol absorption inhibitor ezetimibe. This can not only achieve LDL-C targets, but also reduce the occurrence of side effects.

In summary, both atorvastatin and rosuvastatin are "powerful statins" with the same lipid-lowering strength, and are not affected by the time of taking or food. You only need to take the medicine at a fixed time every day. The difference between the two lies in the side effects, liver and kidney effects, and interactions with other drugs. Doctors need to choose to use them according to the different conditions of the patients.

During medication, you need to regularly monitor blood lipid levels and liver and kidney function. If you find any problems, please consult a doctor or pharmacist in time. I am pharmacist Huazi, welcome to follow me and let me be the pharmacist by your side.