SOLAR: Initial rosuvastatin superior to atorvastatin, simvastatin for reaching LDL-C goals in high-risk patients

A greater percentage of patients at high risk for cardiovascular disease are likely to reach target low-density lipoprotein cholesterol (LDL-C) levels with initial treatment with rosuvastatin than with atorvastatin or simvastatin, according to the results of the Satisfying Optimal LDL-C ATP III Goals with Rosuvastatin (SOLAR) trial.

Key Points

A greater percentage of patients at high risk for cardiovascular disease are likely to reach target low-density lipoprotein cholesterol (LDL-C) levels with initial treatment with rosuvastatin than with atorvastatin or simvastatin, according to the results of the Satisfying Optimal LDL-C ATP III Goals with Rosuvastatin (SOLAR) trial, which were published in the journal Mayo Clinic Proceedings.

The randomized, open-label, multicenter trial included 1,632 patients from 145 US clinical centers who were enrolled in a managed care plan. All patients were classified as high-risk for coronary heart disease (CHD) according to National Cholesterol Education Program (NCEP) ATP III criteria (defined as the presence of CHD or risk equivalents conferring a 10-year CHD risk of >20%).

All patients participated in a 6-week dietary lead-in period, during which all cholesterol-lowering treatments were discontinued and all patients were instructed to follow the NCEP ATP III Therapeutic Lifestyle Changes diet. Patients whose LDL-C levels were between 130 mg/dL and 249 mg/dL and whose fasting triglycerides levels were <400 mg/dL after the lead-in period were randomized to open-label rosuvastatin 10 mg/d (n=542), atorvastatin 10 mg/d (n=544), or simvastatin 20 mg/d (n=546) for 6 weeks. Study medication doses were doubled and treatment was continued for an additional 6 weeks in patients not reaching an LDL-C level <100 mg/dL during the initial 6 weeks.

Patients with triglyceride levels >200 mg/dL at baseline who were treated with rosuvastatin achieved the combined goal of an LDL-C level <100 mg/dL and a non-HDL-C level <130 mg/dL by 6 weeks twice as often as those with similar baseline levels who were treated with rosuvastatin when compared with simvastatin.

All treatments were well tolerated, and treatment-emergent adverse events were similar across treatment groups. The authors stated that the data suggest that a starting dose of rosuvastatin 10 mg reduces the need for titration and clinic visits, potentially resulting in lower costs in a managed care setting.

In a related editorial, Carl J. Lavie, MD, et al stated that the results from the SOLAR trial "add to the knowledge regarding the intensity of lipid therapies and add fuel to the fires created by the 'Statin Wars.' Let these wars continue since this heated competition will likely improve overall clinical efficacy and safety of the various available therapies."

SOURCES

Insull W, Ghali JK, Hassman DR, Ycas JW, Gandhi SK, Miller E; for the SOLAR Study Group. Achieving low-density lipoprotein cholesterol goals in high-risk patients in managed care: Comparison of rosuvastatin, atorvastatin, and simvastatin in the SOLAR trial. Mayo Clin Proc. 2007;82:543–550.

Lavie CJ, Milani RV, O'Keefe JH. Statin wars-emphasis on potency vs event reduction and safety [editorial]? Mayo Clin Proc. 2007;82:539–542.