Rosuvastatin appears better than atorvastatin for mortality, cardio, liver outcomes in large database
Six-year all-cause mortality was lower among patients taking rosuvastatin than atorvastatin, but the difference was only about a percentage point, a study of patients in the United Kingdom and China found.
Rosuvastatin may have lower rates of all-cause mortality, major adverse cardiovascular events (MACE), and major adverse liver outcomes than atorvastatin, a study found.
To compare the real-world effectiveness and safety of the two statins, researchers conducted an active comparator cohort study using target trial emulation for data from the China Renal Data System and UK Biobank databases. Results were published Oct. 29 by Annals of Internal Medicine.
Among 285,680 eligible participants in both databases, six-year all-cause mortality was lower with rosuvastatin than atorvastatin (2.57 vs. 2.83 per 100 person-years in the Chinese database and 0.66 vs. 0.90 per 100 person-years in the UK database), with differences in cumulative incidence of −1.03% (95% CI, −1.44% to −0.46%) and −1.38% (95% CI, −2.50% to −0.21%), respectively. Rosuvastatin was also associated with lower risks for MACE and major adverse liver outcomes. In the UK database, risk for type 2 diabetes was higher with rosuvastatin, and the two drugs had similar risks for chronic kidney disease and other statin-related adverse effects.
The association between rosuvastatin use and lower all-cause mortality compared to atorvastatin may be largely attributable to its stronger cardiovascular protective effect, which in turn may stem from it being more effective than atorvastatin at reducing low-density lipoprotein cholesterol and inflammatory markers, such as C-reactive protein, the study authors said. Other studies have suggested but not confirmed a difference between rosuvastatin and atorvastatin in protecting against MACEs, and rosuvastatin has a lower likelihood for drug interactions than other statins, they noted.
The lower risk of adverse liver outcomes might be attributable to rosuvastatin's antioxidant and anti-inflammatory activities, but specific differences in hepatic effects between rosuvastatin and atorvastatin have not been comprehensively examined, the study authors cautioned. They also noted that despite use of a target trial emulation with two large national cohorts linked to national death registries, only small differences were found in important outcomes, and the confidence intervals did not always meet the requirements for statistical significance.
However, the associations between rosuvastatin and the outcomes remained similar across sensitivity analyses and persisted when defined daily dose and the indications for statin therapy were accounted for, the authors concluded. “These findings emphasize that some of the clinical outcomes associated with starting rosuvastatin treatment differ from the clinical outcomes associated with starting atorvastatin treatment, and clinicians might want to consider these differences when prescribing one of these drugs to individual patients,” they wrote.