Comparative Effectiveness and Safety of High-Intensity Statins (Atorvastatin vs Rosuvastatin) in Coronary Heart Disease Patients After Percutaneous Coronary Intervention (PCI) : A Literature Review / Article Review Perbandingan Efektivitas dan Keamanan Statin Intensitas Tinggi (Atorvastatin vs Rosuvastatin) Pada Pasien Penyakit Jantung Koroner Pasca Percutaneous Coronary Intervantion (PCI) : Literature Review

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.

Latar Belakang Penyakit jantung coroner merupakan salah satu penyebab morbiditas dan mortalitas di dunia, terutama di Indonesia. Penyakit jantung coroner berkaitan erat dengan dislipidemia, terutama peningkatan low-density lipoprotein (LDL) yang berperan penting dalam pembentukan arterosklerosis. Terapi statin intensitas tinggi di rekomendasikan pada pasien penyakit jantung coroner pasca percutaneous coronary intervention (PCI) untuk menurunkan LDL secara optimal dan menurunkan kejadian major adverse cardiovascular event (MACE) karena adanya efek pleiotropik. Tujuan meninjau bukti ilmiah mengenai efektivitas, keamanan, luaran klinis penggunaan statin intensitas tinggi pada pasien penyakit jantung coroner pasca-PCI berdasarkan literatur terkini. Metode Literatur di peroleh dari basis data PubMed, Scopus, dan Google Scholar yang di publikasikan dalam sepuluh tahun terakhir. Studi yang diikutsertakan terdiri atas uji klinis acak, studi kohort retrospektif dan prospektif, studi observasional, systematic review dan meta-analysis, serta narrative review. Outcome yang dievaluasi meliputi pencapaian target LDL, kejadian kardiovaskular mayor (major adverse cardiovascular events [MACE], serta profil keamanan berupa miopati, hepatotoksisitas, diabetes melitus, dan efek samping lainnya. Hasil Sebagian besar penelitian menunjukkan bahwa statin dosis tinggi efektif menurunkan kadar LDL dan memberikan manfaat klinis pada pasien penyakit kardiovaskular. Perbandingan atorvastatin 40 mg dan 80 mg menunjukkan efektivitas yang serupa dalam menurunkan LDL dengan kejadian efek samping yang rendah dan masih dapat ditoleransi. Pada pasien pasca PCI, atorvastatin 80 mg dan rosuvastatin 40 mg memiliki efektivitas yang sebanding, meskipun atorvastatin menunjukkan profil keamanan dan efisiensi biaya yang lebih baik. Beberapa penelitian melaporkan bahwa kombinasi statin dosis sedang dengan ezetimibe menghasilkan pencapaian target LDL yang lebih tinggi dibandingkan monoterapi statin dosis tinggi. Selain itu, kombinasi tersebut dikaitkan dengan risiko efek samping otot, peningkatan enzim hati, dan diabetes melitus yang lebih rendah. Meskipun demikian, sebagian besar pasien berisiko tinggi masih belum mencapai target LDL yang direkomendasikan, sehingga diperlukan strategi intensifikasi terapi, termasuk penambahan ezetimibe atau inhibitor PCSK9.