Rosuvastatin, a potent statin for cardiovascular risk reduction, has raised concerns about QTc interval prolongation, a risk factor for torsades de pointes and sudden cardiac death. This study investigates the short-term effect of rosuvastatin on QTc interval compared to atorvastatin in patients with suspected coronary artery disease (CAD).
In a single-blind, randomized controlled trial at Ningbo Medical Centre Lihuili Hospital (August 2023–May 2024), 522 patients were randomized to receive rosuvastatin (10 mg) or atorvastatin (20 mg) daily. Patients with prior statin use, known QT-prolonging drugs, or severe cardiac conditions were excluded. ECGs were performed at baseline and after two doses, with QTc calculated using Bazett’s formula. Primary outcome was newly emerged QT prolongation (>450 ms males, >470 ms females); secondary outcomes included increased QTc and severe QT prolongation (>500 ms or >60 ms increase). Log-binomial and logistic regression adjusted for confounders.
Of 466 patients analyzed (228 rosuvastatin, 238 atorvastatin), rosuvastatin increased QTc by 6.57 ± 20.32 ms (p<0.001), while atorvastatin showed no change (-0.83 ± 22.07 ms, p=0.563). Rosuvastatin was associated with higher rates of newly emerged QT prolongation (9.2% vs. 4.2%, p=0.030; RR 1.42, p=0.008) and increased QTc (62.7% vs. 46.6%, p<0.001; RR 1.35, p=0.001). Severe QT prolongation rates were similar (2.6% vs. 1.7%, p=0.537). Rosuvastatin was an independent risk factor for QT prolongation (OR 2.57, 95% CI 1.12–5.90, p=0.025) after adjusting for age, heart failure, and atrial fibrillation. No torsades de pointes occurred.
Rosuvastatin significantly increases QTc interval and risk of QT prolongation compared to atorvastatin in the short term, though severe prolongation is uncommon. Enhanced QTc monitoring is recommended for patients on rosuvastatin, particularly with concurrent QT-prolonging drugs.
Source: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-09010-6
