rosuvastatin and primary cardiovascular prevention New Indication Continue to use pravastatin or simvastatin

摘要

When a patient who has never had a cardiovascular event, i.e. primary cardiovascular prevention, requires cholesterol-lowering drug therapy, pravastatin and simvastatin are first-choice drugs (1). Rosuvastatin (Crestor0, AstraZeneca) is now authorised in this setting, based on unplanned subgroup analyses of a placebo-controlled trial (the Jupiter study) involving 17 802 patients with no prior cardiovascular history (1 -3).In February 2009 we concluded that the risk-benefit balance of rosuvastatin was uncertain in the overall Jupiter study population (1). Since then, new results for cardiovascular mortality (0.4% with rosuvastatin and 0.5% with placebo; p=0.315) have not challenged our earlier conclusions (2). Retrospective subgroup analyses, which are inherently unreliable, suggest that rosuvastatin reduced the incidence of an endpoint combining various cardiovascular events in "high-risk" patients, but not overall mortality (3).