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Rosuvastatin

Classification: A

Drug products: Crestor, Crestor®, Rosuvastatin Accord, Rosuvastatin Glenmark, Rosuvastatin Krka d.d., Rosuvastatin Medical Valley, Rosuvastatin Orion, Rosuvastatin Sandoz, Rosuvastatin STADA, Rosuvastatin Teva, Visacor

ATC code: C10AA07

Substances: rosuvastatin, rosuvastatin calcium

Summary

In studies with sex-divided statistics, rosuvastatin have shown similar effect in men and women.
A large register-based study has shown men and women to have similar risk of moderate to serious adverse musle effects.
 
The present evidence concerning differences between men and women is limited and do not motivate differentiation in dosing or treatment.

Additional information

Pharmacokinetics and dosing

Several studies have found no sex differences in rosuvastatin pharmacokinetics [1-3]. However, a small Chinese study (6 men, 6 women), found a 5% lower AUC and 6.5% lower mean Cmax in men than in women [4]. Since no sex differences have been found for rosuvastatin pharmacokinetics [1-3], no dosage adjustment based on sex is considered necessary.

Effects

Primary preventionIn the JUPITER trial (11001 men, 6801 women), rosuvastatin treatment (20 mg/day) of healthy individuals with elevated high sensitivity CRP and low LDL cholesterol resulted in similar risk reductions in cardiovascular disease events in both men and women. However, women had greater reduction in revascularization/unstable angina and men had greater reduction in stroke. Subgroup analysis suggested that women with a family history of premature coronary disease may benefit more from rosuvastatin therapy than those without [5, 6].The efficacy of rosuvastatin 40 mg on changes in carotid intima-media thickness (CIMT) was measured in the randomized, placebo-controlled METEOR trial. Results show that rosuvastatin slowed progression of maximum CIMT over 2 years and results were consistent in men and women [7].

Secondary preventionThe CORONA trial included patients with systolic heart failure (EF<40%), due to ischemic heart disease (3831 men, 1180 women). In this trial rosuvastatin did not reduce death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, in patients with systolic heart failure. Rosuvastatin did reduce the number of cardiovascular hospitalizations. The treatment effect was consistent in men and women [8].

Adverse effects

In the JUPITER trial, rates of muscle disorders or myopathy were similar in men and women regardless of treatment assignment [5, 6].In a large register-based cohort study (121 148 men, 104 744 women), the risk of moderate to serious myopathy was higher in men than in women for lipophilic statins such as simvastatin and atorvastatin. However, for the hydrophilic statins such as rosuvastatin and pravastatin there were no sex differences in the risk of myopathy. Adjusted hazard ratio for rosuvastatin-induced myopathy was 4.2 in men (95%CI 1.9-9.5) vs. 5.4 in women (95%CI 2.6-11.1) [9].Most large pivotal studies, even recent ones, have not performed relevant sex-analyses of side effects [10].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

A meta-analysis of controlled clinical trials (413 men, 480 women) report that among hyperlipidemic patients who receive long-term rosuvastatin treatment (10 mg/day for > 96 weeks), GFR was unchanged regardless of sex. This suggests that rosuvastatin may arrest the progression of renal disease [11].

Updated: 2019-02-26

Date of litterature search: 2014-05-21

References

  1. Martin PD, Dane AL, Nwose OM, Schneck DW, Warwick MJ. No effect of age or gender on the pharmacokinetics of rosuvastatin: a new HMG-CoA reductase inhibitor. J Clin Pharmacol. 2002;42:1116-21. PubMed
  2. Li Y, Jiang X, Lan K, Zhang R, Li X, Jiang Q. Pharmacokinetic properties of rosuvastatin after single-dose, oral administration in Chinese volunteers: a randomized, open-label, three-way crossover study. Clin Ther. 2007;29:2194-203. PubMed
  3. Zhou Q, Ruan ZR, Yuan H, Xu DH, Zeng S. ABCB1 gene polymorphisms, ABCB1 haplotypes and ABCG2 c421c > A are determinants of inter-subject variability in rosuvastatin pharmacokinetics. Pharmazie. 2013;68:129-34. PubMed
  4. Li Y, Jiang X, Lan K, Jiang Q. Comparative single- and multiple-dose pharmacokinetics of rosuvastatin following oral administration in Chinese volunteers. Eur J Drug Metab Pharmacokinet. 2009;34:221-7. PubMed
  5. Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM, Kastelein JJ et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195-207. PubMed
  6. Mora S, Glynn RJ, Hsia J, MacFadyen JG, Genest J, Ridker PM. Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials. Circulation. 2010;121:1069-77. PubMed
  7. Crouse JR, Raichlen JS, Riley WA, Evans GW, Palmer MK, O'Leary DH et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: the METEOR Trial. JAMA. 2007;297:1344-53. PubMed
  8. Kjekshus J, Apetrei E, Barrios V, Böhm M, Cleland JG, Cornel JH et al. Rosuvastatin in older patients with systolic heart failure. N Engl J Med. 2007;357:2248-61. PubMed
  9. Hippisley-Cox J, Coupland C. Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ. 2010;340:c2197. PubMed
  10. Finegold JA, Manisty CH, Goldacre B, Barron AJ, Francis DP. What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice. Eur J Prev Cardiol. 2014;21:464-74. PubMed
  11. Vidt DG, Cressman MD, Harris S, Pears JS, Hutchinson HG. Rosuvastatin-induced arrest in progression of renal disease. Cardiology. 2004;102:52-60. PubMed
  12. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-05.] länk

Authors: Linnéa Karlsson Lind, Desirée Loikas

Reviewed by: Mia von Euler, Expertrådet för hjärt-kärlsjukdomar

Approved by: Karin Schenck-Gustafsson