Article Review Perbandingan Efektivitas dan Keamanan Statin Intensitas Tinggi (Atorvastatin vs Rosuvastatin) Pada Pasien Penyakit Jantung Koroner Pasca Percutaneous Coronary Intervantion (PCI) : Literature Review

Abstract

Background Coronary heart disease is one of the causes of morbidity and mortality worldwide, especially in Indonesia. Coronary heart disease is closely associated with dyslipidemia, particularly increased low-density lipoprotein (LDL), which plays an important role in the formation of atherosclerosis. High-intensity statin therapy is recommended for patients with coronary heart disease after percutaneous coronary intervention (PCI) to optimally reduce LDL and reduce the incidence of major adverse cardiovascular events (MACE) due to its pleiotropic effects. Objective To review the scientific evidence regarding the effectiveness, safety, and clinical outcomes of the use of high-intensity statins in patients with coronary heart disease after PCI based on the current literature. Methods The literature was obtained from the PubMed, Scopus, and Google Scholar databases published within the last ten years. The included studies consisted of randomized clinical trials, retrospective and prospective cohort studies, observational studies, systematic reviews and meta-analyses, and narrative reviews. The evaluated outcomes included LDL target achievement, major adverse cardiovascular events (MACE), and safety profiles including myopathy, hepatotoxicity, diabetes mellitus, and other adverse effects. Results Most studies showed that high-dose statins effectively reduced LDL levels and provided clinical benefits in patients with cardiovascular disease. A comparison of atorvastatin 40 mg and 80 mg showed similar effectiveness in reducing LDL, with a low incidence of adverse effects and still tolerable. In patients after PCI, atorvastatin 80 mg and rosuvastatin 40 mg had comparable effectiveness, although atorvastatin showed a better safety profile and cost efficiency. Several studies reported that the combination of moderate-dose statins with ezetimibe resulted in higher achievement of LDL targets compared with high-dose statin monotherapy. In addition, the combination was associated with lower risks of muscle-related adverse effects, increased liver enzymes, and diabetes mellitus. Nevertheless, most high-risk patients still do not achieve the recommended LDL target, so treatment intensification strategies are needed, including the addition of ezetimibe or PCSK9 inhibitors.