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Rosuvastatin for cardiovascular disease prevention

Rosuvastatin is an HMG-CoA reductase inhibitor (statin) that reduces low-density lipoprotein cholesterol (LDL-C) levels. From 1 December 2021, it became fully funded for the management of cardiovascular disease and familial hypercholesterolaemia for patients meeting Special Authority criteria.1 

This Medcase describes the safe prescribing of rosuvastatin for the prevention of cardiovascular disease.

Statins for primary prevention of cardiovascular disease

As per the New Zealand Cardiovascular Risk Assessment and Management guidelines, patients with a CVD risk of between 5 and 15% should be offered dietary and lifestyle interventions along with consideration of lipid-lowering or blood pressure-lowering pharmacotherapy, based on an individualised assessment of risks and benefits.2

A discussion of dietary and lifestyle modification is beyond the scope of this MedCase but further information can be found in the Cardiovascular Disease Risk Assessment and Management for Primary Care.2,3

Statins are the preferred first-line medications for lipid management, for both primary and secondary prevention of CVD events.2,4,5

Multiple, robust clinical trials have demonstrated that statins reduce the risk for nonfatal myocardial infarction, ischemic stroke, need for revascularization, and cardiovascular and all-cause mortality.5 They have also been shown to stabilize and even regress established atherosclerotic plaque. Each 1 mmol/L reduction in LDL-C confers a 25% reduction in relative risk of CVD events over 5 years.3 Reductions in LDL-C of >50% can be achieved in people with baseline LDL-C of >4 mmol/L, and CVD risk continues to decline commensurate with LDL-C with no evidence of waning risk reduction even at very low levels of LDL-C.2

In addition to diet and lifestyle changes, Mrs R could benefit from lipid-lowering therapy. Current guidelines recommend a target reduction in LDL-C of at least 40% i.e. target LDL-C of 2.52 mmol/L.

Getting to the heart of inequities in CVD prevention

The burden of CVD and related mortality and morbidity is inequitably distributed in New Zealand. The rate of mortality from CVD is more than double for Māori than for non-Māori (RR 2.17, CI 2.08–2.26), and hospitalisations for CVD are over 1.5 times more common for Māori.6 

Māori and Pacific peoples have greater exposure to CVD risk factors compared with other ethnic groups in New Zealand,7 yet are less likely to be prescribed statins for secondary prevention of CVD.8

The pro-equity Special Authority criteria for funding rosuvastatin aims to address these inequities by making rosuvastatin available as first-line therapy for any Māori or Pacific patient at risk of cardiovascular disease.


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