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Abstract & Commentary
By Michael H. Crawford, MD, Professor of Medicine, and Chief of Clinical Cardiology, at the University of California, San Francisco. Dr. Crawford is on the speaker's bureau for Pfizer.
Source: Backes JM, et al. Effects of Once Weekly Rosuvastatin Among Patients With a Prior Statin Intolerance. Am J Cardiol. 2007;100:554-555.
Statins are usually well tolerated, but some patients have adverse effects even on every other day therapy. These investigators describe the results of once a week rosuvastatin in 10 patients intolerant to once-a-day statins due to myalgias, high liver function tests and gastrointestinal side effects. Once-weekly rosuvastatin was dosed between 5-20mg (most were on 10mg) and the patients were followed for an average of 4 months. Two patients could not tolerate once-a-week therapy because of the same side effects. The other 8 experienced an average LDL cholesterol drop of 29% (range -6 to -62%). HDL rose in 5 of the 8 (14 to 45%) and dropped in 3 (-4 to -27%). Triglycerides were unchanged overall. The authors concluded that once-a-week rosuvastatin may be an effective option for those intolerant to once-daily statin.
Statins are our most effective agents for lowering high levels of LDL cholesterol in patients with atherosclerosis. Although well tolerated by most, a few patients have intolerable adverse reactions. Common strategies included lowering the dose and every-other-day dosing for such patients, but these measures do not always work. This report describes 8 out of 10 patients tried on once-weekly rosuvastatin who had success with LDL lowering and tolerability. The reason for this success is not clear, but rosuvastatin is very potent and has a long half life.
In the acute coronary syndrome patients where the target is an LDL < 85 mg/dL, the average 29% drop may not achieve this target. However, evidence suggests that some lipid lowering is better then none. Also, diet, niacin, ezetimibe and other agents may help achieve targets with this low-level background statins, without increasing adverse effects. In patients in whom LDL lowering is critical, this approach would certainly be worth trying in those who cannot tolerate statins. The only contradiction would be life-threatening adverse effects.