Effect of Atorvastatin and Rosuvastatin on Lipid Parameters and Inflammatory Biomarkers in Patients with Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Statins produce marked reductions in total and LDL cholesterol, C-reactive protein (CRP), and help prevent stroke, re-infarction, and subsequent risk of death. We conducted a meta-analysis to assess the role of atorvastatin in comparison with rosuvastatin in lowering levels of inflammatory biomarkers and lipid parameters in patients with ACS. Online databases were searched, and results from random-effects meta-analysis are presented as weighted mean differences (WMDs) and corresponding 95% confidence intervals. The outcomes were assessed at the short-term (≤1 month) and long-term (>3 months) follow-up. A total of 15 studies (13 RCTs and 2 observational studies) were included. The level of erythrocyte sedimentation rate (P = 0.13), oxidized LDL (P = 0.94), and long-term HDL-C (P = 0.28) showed no significant difference between the two statin groups. No significant differences were observed between atorvastatin and rosuvastatin in total cholesterol and LDL-C at short-term or long-term follow-up. A significant decrease in CRP levels (WMD 4.08; 95% CI 1.53-6.63; P = 0.002; I2 = 98%) and a significant rise in HDL-C (WMD -1.15; 95% CI -1.99 to -0.32; P = 0.007; I2 = 39%) was reported in the rosuvastatin group compared to the atorvastatin group in the short-term. Atorvastatin was associated with a significant reduction in triglycerides at short-term follow-up (WMD -8.69; 95% CI -14.97 to -2.40; P = 0.007; I2 = 35%), while the overall long-term comparison was borderline and did not reach conventional statistical significance. Our findings suggest that rosuvastatin may provide greater short-term reductions in CRP and modest increases in HDL-C compared with atorvastatin; however, these findings should be interpreted cautiously because of substantial heterogeneity and the absence of significant differences at longer follow-up.