I concur with Blenkinsopp that too high a dose range for rosuvastatin has been proposed by the company. The company’s recommendation for the initial dose is 10 mg, which reduces LDL-cholesterol by an average of 46–52%. This reduction far exceeds the recommendation by the National Cholesterol Education Program of a 30–40% reduction in LDL-cholesterol for high-risk patients. Indeed, the lowest dose of rosuvastatin that is marketed, 5 mg, reduces LDL-cholesterol by 45% on average, still more than initially necessary for many patients.
Not mentioned in the recent ATP3 guidelines is the fact that 2.5 mg and 1 mg of rosuvastatin reduce LDL-cholesterol by an average of 42% and 34%, respectively.
These doses therefore seem adequate to me when starting high-risk patients on rosuvastatin. However, even such low doses could be excessive for people in the moderate risk categories whose LDL-cholesterol only needs to be reduced by 20–30%. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17304-2/fulltext
Since the lowest dosing of rosuvastatin is 5 mg, personally I would strongly consider taking 1/2 of 5 mg so 2.5 mg every OTHER day for potential 30-40% reduction to minimize side effects and cost would be ridiculous.
If our goal is to bring LDL-C as low as possible (which we have good indications for that we should), then taking moderate to high doses is preferred. Particularily if paired with diabetes medication such as empagliflozin.
I have read that Rosuvastatin dose prescriptions are generally much lower in Europe than in the US.
As an add-on: I am wondering if the dose of Repatha is also higher than it needs to be. I was on Repatha and it significantly lowered all lipids, including Lp(a), except slightly raised Trigs. But – it elevated glucose and insulin dropped to 2! It is known to do this in some patients – increases LDL receptors on the pancreas as well as the liver and this leads to the Beta cells putting out less insulin. I would probably be OK with a lower dose as I do not need that much lowering. I am now on a break from the Repatha since it only comes in the one-size-fits-all dose and I want to do a washout while considering what to do next. If I resume, maybe once a month rather than every two weeks. Or even every 5-6 weeks. Or wait for Pelacarsen. Or take about 1 gram of Rosuvastatin. Thanks for your post about lower dose of Rosuvastatin!
Do you have any data showing empagliflozin decreases risk of diabetes? And why wouldn’t you switch to atorvastatin if you wanted to decrease that risk?
Personally I suspect that once you drop under 70 and further benefits from going below are pretty much non-existent (it’s the bottom of the logarithmic curve) especially if you are correcting for all other risk factors. At that point pushing the statin dose will only expose you potential side effects, thus altering your risk to benefit ratio.
For example my LDL-C is 80 currently, I could take 10 mg of rosuvastatin and drop it to 40… or I can take ten times less and drop it to 50. I cannot imagine my risk of CAD will change in any meaningful way at 40 vs 50.
The average adult has an LDL-C of 130. To achieve levels below 70, they need a 50% reduction in LDL-C which is only achievable by using 10mg rosuvastatin or 5mg of rosuvastatin and 10mg of ezetimibe daily.
But that applies to most disease processes. We don’t aim for a percentage decrease in blood pressure or blood sugar?
In your example you’re technically aiming for 70, not strictly a percent.
“So if I am shooting for 70 and starting at 100, 30% gets me there.
If I start at 140 I will need 50%.”