Rosuvastatin is the latest and most potent statin currently on the market. It has the greatest efficacy compared with all other available statins on total cholesterol and low-density lipoprotein cholesterol (LDL-C) reduction, and also provides a significant increase in high-density lipoprotein cholesterol (HDL-C) better than atorvastatin. Imaging studies showed a regression of atheroma in secondary prevention patients using an intravascular ultrasound technique and a hold of progression in primary prevention patients using carotid intima-media thickness as a surrogate marker. The JUPITER trial, a primary prevention large-scale, prospective study to examine the role of statin therapy in individuals with raised C-reactive protein but normal LDL-C levels, was recently terminated early due to a significant reduction of events in the rosuvastatin group. Rosuvastatin has held its initial promises as a very potent statin, with favourable effects on HDL, showing a regression or a halt of the atherosclerotic burden and reducing cardiovascular events in low-risk patients.
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Department of Clinical Pharmacy, China Pharmaceutical University, School of Basic Medicine and Clinical Pharmacy, Nanjing, China.
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Department of Medical Analysis, Faculty of Applied Science, Tishk International University, KRG, Erbil, Iraq.
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Given the apparent inconsistency of having potent lipid-lowering drugs and the unacceptable rate of achievement of therapeutic goals in LDL cholesterol, it is imperative to define new strategies. In this regard, it is appropriate to detail the key points in planning to start lipid-lowering therapy, emphasizing relevant clinical aspects such as the considerable individual variability in the response to statin therapy, positioning in relation to high-potency statins versus statin+ezetimibe combination therapy, and the order of choice of lipid-lowering drugs in the therapeutic strategy. An algorithm is then proposed that ensures a personalized approach to lipid-lowering drug treatment in patients with cardiovascular disease and/or familial hypercholesterolemia with the aim of achieving the therapeutic goal in the shortest possible time, taking into account the patient's previous treatment, the funding criteria for new drugs, and the individualized goal of LDL cholesterol reduction.
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