Comparison of Rosuvastatin and Atorvastatin Regimens in the Achievement of LDL-C Goals: A Malaysian Real-World Cohort Study.

Abstract

Background: Despite potent lipid-lowering therapies (LLT), achieving low-density lipoprotein cholesterol (LDL-C) targets remains challenging, especially in high-risk populations. This study evaluated the comparative efficacy of atorvastatin and rosuvastatin regimens and goal attainment within a Malaysian public tertiary care setting. Methodology: We conducted a retrospective cohort study of adults treated with atorvastatin or rosuvastatin (as monotherapy or combined with ezetimibe) at Hospital Taiping. Patients with continuous treatment (≥12 months) and paired lipid profiles (baseline 2022; follow-up 2023) were included. The primary outcome was 2019 ESC/EAS guideline target achievement. The secondary outcome was the mean reduction in LDL-C levels. Results: A total of 255 patients were included. Overall, only 19.2% (49/255) achieved their risk-stratified LDL-C targets. Goal attainment was notably poor in the high- and very-high-risk subgroups, with 85.8% failing to reach targets. Rosuvastatin plus ezetimibe demonstrated the greatest mean LDL-C reduction, significantly outperforming atorvastatin monotherapy (mean difference (MD) 0.65 mmol/L, p=0.045) and atorvastatin plus ezetimibe (MD 0.59 mmol/L, p=0.013). Analysis of treatment gaps revealed that 46.6% (96/206) of patients who failed to reach targets had not been titrated to the maximum tolerated statin dose. Conclusion: While rosuvastatin plus ezetimibe emerged as the most effective regimen, overall goal attainment remained suboptimal. Clinical inertia was a primary barrier, evidenced by the high proportion of uncontrolled patients remaining on sub-maximal doses. To bridge this gap, institutional strategies in the public health setting must prioritize earlier initiation of combination therapy and automated prompts for dose intensification in high-risk individuals.