Twenty-six studies (approximately 6,912 participants) were included in the review: 17 studies used head-to-head comparisons (n=4,319) and nine used forced titration comparisons (n=1,873).
Rosuvastatin 5mg/day versus 10 mg/day: Significant benefit was reported for higher dose rosuvastatin for LDL-C (WMD 6.25%, 95% CI 4.93% to 7.57%; 12 RCTs), total cholesterol/HDL-C ratio (WMD 4.76 %, 95% CI 3.58% to 5.94%, I2=54.7%) and apoB/apoA-I ratio (WMD 5.18%, 95% CI 3.81 to 6.54, I2=26.9%). Benefit was reported for higher dose rosuvastatin for HDL-C, but this did not reach statistical significance.
Rosuvastatin 10mg/day versus 20 mg/day: Significant benefit was reported for higher dose rosuvastatin for LDL-C (WMD 5.84% 95% CI 5.13 to 6.56; 17 RCTs), HDL-C (WMD -0.78%, 95% CI -1.44% to -0.12%, I2=33.9%), total cholesterol/HDL-C ratio (WMD 4.56%, 95% CI 3.88% to 5.23%) and apoB/apoA-I ratio (WMD 4.75%, 95% CI 3.86% to 5.63%).
Rosuvastatin 20mg/day versus 40mg/day: There was significant benefit reported for higher dose rosuvastatin for LDL-C (WMD 5.03%, 95% CI 4.28% to 5.79%; 13 RCTs), total cholesterol/HDL-C ratio (WMD 3.40%, 95% CI 2.63% to 4.18%) and apoB/apoA-I ratio (WMD 2.82%, 95% CI 1.60% to 4.04%). Greater benefit was reported for the lower dose of rosuvastatin for HDL-C, but this was not statistically significant.
When one study that included patients with Fredrickson type IIb or IV hypertriglyceridaemia was removed from the analysis, heterogeneity was reduced or removed (further details were reported). Sensitivity analyses did not significantly alter results (data not presented). Results of subgroup analyses were reported.
Tolerability: There were no significant differences for any adverse events for comparisons of rosuvastatin for 5mg/day and 10mg/day, and between 10mg/day and 20mg/day. There was a significantly higher risk of proteinuria with rosuvastatin 40mg/day compared to 20mg/day (RR 0.30, 95% CI 0.12 to 0.76). There were no significant differences between groups for other adverse events. There was evidence of low heterogeneity for the comparison between 20mg/day and 40mg/day rosuvastatin for myalgia (I2=24%). The results of sensitivity and subgroup analyses were similar (data not presented). There were no reports of rhabdomyolysis, myopathy, liver failure or hepatitis for any of the rosuvastatin dosages.