1. In this multi-database retrospective cohort study, rosuvastatin was found to be associated with slightly decreased risk of all-cause mortality and major adverse cardiovascular events compared with atorvastatin.

2. Initiation of rosuvastatin and atorvastatin carried similar risks for the development of chronic kidney disease.

Evidence Rating Level: 2 (Good) 

Study Rundown: Atorvastatin and rosuvastatin are both widely prescribed for reducing LDL-C levels. However, there is a lack of conclusive evidence on the comparison between these statins regarding cardiovascular events, organ protection, the risk of new-onset diabetes, and overall survival. Using databases from the UK and China, this cohort study aimed to assess the risks of atorvastatin and rosuvastatin for all-cause mortality, major adverse cardiovascular events (MACEs), major adverse liver outcomes (MALOs), development of type 2 diabetes mellitus (T2DM), and other adverse events related to statin use. The risk of all-cause mortality within 6 years of statin use was found to be slightly lower in rosuvastatin users compared with atorvastatin users. The risks of developing MACEs and MALOs were also slightly lower with rosuvastatin use. Rosuvastatin appeared to reduce the risk of all-cause mortality and MACEs regardless of whether it was used for primary or secondary prevention of cardiovascular events. Overall, rosuvastatin users had a similar risk of developing CKD compared with atorvastatin users. Among British participants, however, those who started rosuvastatin had a higher risk of developing T2DM compared to those who started atorvastatin; this was not seen in Chinese participants. No significant differences were seen between atorvastatin and rosuvastatin in the development of statin-related adverse effects. The generalizability of this study was limited by the potential for residual confounding, failure to assess potential links between other statins and outcomes, and the fact that the participants used only one of the two medications assessed. Nevertheless, this study demonstrated how atorvastatin and rosuvastatin may affect secondary outcomes and showed that rosuvastatin may be better for reducing all-cause mortality and cardiovascular events. However, many of its findings were not statistically significant, and further research may be needed to guide clinical practice.

Click to read the study in AIM

Relevant Reading: Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial

In-Depth [retrospective cohort]: This study aimed to assess the effectiveness of atorvastatin versus rosuvastatin in reducing all-cause mortality, MACEs, MALOs, risk of developing CKD, and risk of new-onset T2DM. Participants were taken from the China Renal Data System (CRDS) and UK Biobank (UKB) databases. Inclusion criteria included age above 16 years and initiation of atorvastatin or rosuvastatin between 2012 and 2022 if they were from the CRDS database and between 2006 and 2010 if from the UKB database. Participants were excluded if they used both drugs simultaneously or if they had already started using one of the two drugs before baseline. The primary outcome was all-cause mortality, while secondary outcomes were MACEs, MALOs, development of CKD, and development of new-onset T2DM. A total of 285,680 participants were identified across the two databases; the median age was in the mid-60s (65 years for participants from the CRDS database and 66 years for participants from the UKB database), and over 55% were male. Mean follow-up was 4.6 years for participants from the CRDS database and 9.8 for participants from the UKB database. Among 140,346 participants from both databases, the all-cause mortality risk difference (RD) for rosuvastatin compared with atorvastatin was -1.03% (95% CI, -1.44% to -0.46%) for the CRDS cohort and -1.38% (95% CI, -2.50% to -0.21%) for the UKB cohort. Rosuvastatin also had a lower hazard ratio (HR) for all-cause mortality in both the CRDS (0.91 [95% CI, 0.88 to 0.94]) and UKB (0.74 [95% CI, 0.58 to 0.94]) cohorts. Among 43,796 participants from the CRDS database, the MACE RD for rosuvastatin was -0.94% (95% CI, -1.67% to -0.19%) and the HR was 0.89 (95% CI, 0.85 to 0.95); in the UKB database, the MACE RD was -2.11% (95% CI, -3.73% to -0.48%) and the HR was 0.71 (95% CI, 0.55 to 0.90). The incidence rate for MALOs among 89,174 participants from the CRDS database was 0.59 per 100 person-years for rosuvastatin versus 0.67 for atorvastatin, yielding an RD of -0.30% (95% CI, -0.72% to 0.09%); the RD in the UKB cohort was -1.14% (95% CI, -1.83% to -0.42%). Data from 62,532 participants from the CRDS database showed a CKD RD of 0.70% (95% CI, -0.22% to 1.55%) between rosuvastatin and atorvastatin; in the UKB cohort, made up of 4792 participants, the CKD RD was 0.03% (95% CI, -1.40% to 1.38%). The T2DM RD among 64,762 CRDS participants was 1.50% (95% CI, 0.02% to 2.46%), while among 5,502 UKB participants, the RD was -0.21% (95% CI, -1.06% to 0.72%). Finally, the statin-related adverse effects RD was -0.28% (95% CI, -1.45% to 0.85%) for the CRDS cohort and -0.14% (95% CI, -0.91% to 0.62%) for the UKB cohort. Overall, this study showed that rosuvastatin had a lower risk of all-cause mortality and MACEs, but many findings were not statistically significant and thus may require further validation.

Image: PD

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