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Research Paper
Received: 16-07-14
Revised: 17-10-2014
Accepted: 14-02-2015
ABSTRACT
Objectives: To compare antiinflammatory effect of atorvastatin and rosuvastatin in patients of acute coronary
syndrome. Materials and Methods: The study was a prospective, openlabeled, randomized and singlecenter
study conducted on 100patients of acute coronary syndrome. Patients were assigned to atorvastatin 40 mg daily
or rosuvastatin 20 mg daily for 4weeks. Creactive protein(CRP) levels, lipid profiles, erythrocyte sedimentation
rate (ESR) and adverse effects were measured at beginning and at the end of 4weeks. Results: Baseline
parameters and clinical profile did not differ between the two groups. CRP levels significantly decreased from
beginning to the end of 4weeks in both atorvastatin and rosuvastatin groups(from 35.48 to 23.07 mg/l and from
35.88 to 19.91 mg/l respectively, both P<0.001). However, there was significant difference between the levels of
CRP in patients of the rosuvastatin group as compared to the atorvastatin group(19.916.32 vs 23.077.47,
P<0.05). In addition, both the drugs were associated with a reduction in total cholesterol, LDL levels and
ESR at the end of 4weeks as compared to the beginning(P<0.001 for all comparisons). Conclusion: Both
atorvastatin(40 mg) and rosuvastatin(20 mg) are effective in decreasing CRP and LDL cholesterol levels
even in a short duration of 4weeks. Rosuvastatin was found to be more effective in decreasing CRP levels.
Key words: Acute coronary syndrome, inflammation, statins
INTRODUCTION
Cardiovascular diseases are a leading cause of morbidity and
mortality in both developed and developing countries and
account for around 17 million deaths worldwide and 1.5 million
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DOI:
10.4103/0976-500X.162011
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RESULTS
Effect on CRP in both groups
Table1 shows changes in CRP levels in the patients of both
groups.
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DISCUSSION
This randomized study was undertaken to compare the
antiinflammatory effect of atorvastatin and rosuvastatin in the
Groups
Baseline
4 weeks
P*
P#
0.02
35.4811.65
23.077.47
34.843.68
<0.001
35.889.87
19.916.32#
44.546.79
<0.001
In each group as compared to baseline, #Inter group comparison, n=50 in each group, CRP=C-reactive protein, ESR=Erythrocyte sedimentation rate
Groups
Baseline
4 weeks
P*
P#
25.6616.61
22.5714.89
12.383.28
<0.001
0.96
25.4511.80
22.4510.26
11.503.85
<0.001
In each group as compared to baseline, #Inter group comparison, n=50 in each group, CRP=C-reactive protein, ESR=Erythrocyte sedimentation rate
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Groups
Lipid profile
Group A (Atorvastatin=
40 mg/d)
Group B (Rosuvastatin=
20 mg/d)
Baseline
4 weeks
P*
P#
TC
190.9248.07
140.6237.08
26.404.67
<0.001
0.21
LDL
101.9134.47
64.0822.47
37.065.85
<0.001
0.54
HDL
38.7410.12
38.4410.05
0.781.44
=0.001
0.24
VLDL
50.2724.34
32.6015.77
34.904.33
<0.001
0.43
TG
143.6654.73
140.3153.23
2.282.17
<0.001
0.51
TC
209.1448.92
149.9036.60
28.364.21
<0.001
LDL
109.1331.39
66.7321.69
39.166.16
<0.001
HDL
40.827.52
40.547.56
0.681.43
=0.002
VLDL
59.1927.21
35.1817.35
41.025.35
<0.001
TG
138.6643.86
134.0441.95
3.183.32
<0.001
*In each group as compared to baseline, #Inter group comparison; n=50 in each group; TC=Total cholesterol, LDL=Low density lipoprotein, HDL=High density
lipoprotein, VLDL=Very low density lipoprotein, TG=Triglycerides
Type of ADR
Group (A/B)
Constipation
A
B
A
B
A
B
A
B
A
B
Dyspepsia
Pain abdomen
Myalgia
Headache
Number (%)
5 (10)
4 (8)
4 (8)
4 (8)
1 (2)
2 (4)
1 (2)
1 (2)
0
0
Severity (no.)
a
a
a (2), b (2)
a
a
a
a
a
-
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CONCLUSION
In conclusion, findings of our study showed that both
atorvastatin(40 mg) and rosuvastatin(20 mg) are effective
in decreasing CRP and LDL cholesterol levels even in a short
duration of 4weeks. It is tempting to suggest using CRP as a
surrogate end point or monitoring variable for statin treatment
in addition to LDL cholesterol. This dose of rosuvastatin was
found to be more effective in decreasing CRP level. Both the
drugs were effective, safe and offer an attractive approach for
early treatment of ACS patients.
It is conceivable that clinical benefit afforded by statins if
started early after ACS is partly due to other nonlipidlowering
effects, in which antiinflammatory effect is primary as
manifested by reduction in CRP levels. One common factor
in all the studies which have shown clinical benefit from statin
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