Comparison of the efficacy of rosuvastatin versus atorvastatin in reducing apolipoprotein B/apolipoprotein A-1 ratio in patients with acute coronary syndrome: results of the CENTAURUS study

Summary Background The mechanism underlying statin-induced event reduction in patients with acute coronary syndrome remains unclear. Aims To assess the efficacy of rosuvastatin 20 mg versus atorvastatin 80 mg in reducing the apolipoprotein B/apolipoprotein A-1 (apoB/apoA-1) ratio at 3 months. Non-inferiority of rosuvastatin 20 mg versus atorvastatin 80 mg in reducing low-density lipoprotein cholesterol at 1 and 3 months was also assessed. Methods Patients with non-ST-elevation acute coronary syndrome were enrolled into this randomized, double blind, parallel-group trial. Results In total, 753 patients (369, rosuvastatin 20 mg; 384, atorvastatin 80 mg) were included in the intention-to-treat analysis; 478 patients (226, rosuvastatin 20 mg; 252, atorvastatin 80 mg) were included in the per-protocol analysis. Rosuvastatin 20 mg was more effective than atorvastatin 80 mg in decreasing apoB/apoA-1 ratio at 1 month (−44.4% vs −42.9%, p = 0.02) but not at 3 months (both −44.4%, p = 0.87). Low-density lipoprotein cholesterol decreased by ∼50% after 1 and 3 months in both groups. Non-inferiority of rosuvastatin 20 mg versus atorvastatin 80 mg was demonstrated at 1 month (difference, −0.3% [95% confidence interval, −2.7; +2.1]), but not at 3 months (+1.0% [−1.6; 3.5]) (intention-to-treat analysis). In the per-protocol analysis, non-inferiority of rosuvastatin 20 mg was demonstrated at both 1 (−0.7% [−3.5; 2.0]) and 3 (−0.5% [−3.5; 2.5]) months. Conclusion In patients with non-ST-elevation acute coronary syndrome, rosuvastatin 20 mg decreased apoB/apoA-1 ratio at 1 month more than atorvastatin 80 mg. No difference could be shown at 3 months; thus, the primary endpoint was not met.