Rosuvastatin

Rosuvastatin (Crestor) is a hydrophilic statin with the strongest LDL-lowering effect per milligram in the class.

Mechanism — HMG-CoA reductase inhibition; similar to atorvastatin but more potent and with less hepatic metabolism. Roughly 40-60% LDL reduction at standard doses. Modest HDL elevation.

Use case — High-LDL, secondary prevention. Typical 5-20 mg/day. Often the choice when atorvastatin is poorly tolerated or insufficient.

Caveats — Less drug-interaction burden than atorvastatin (CYP3A4 metabolism). Asian populations are more sensitive — start low. Same muscle-pain and glucose-elevation considerations as the class.