Researchers have found that while rosuvastatin and atorvastatin are two of the most commonly prescribed drugs in managing cholesterol, rosuvastatin may offer some additional benefit over atorvastatin in the context of reducing all-cause mortality. A recent study was conducted by Zhou and colleagues published in the journal Annals of Internal Medicine. This study fills this gap by comparing the outcome of patients who were exposed to rosuvastatin and atorvastatin in two large databases: the China Renal Data System (CRDS) and UK Biobank (UKB).
The aim of the study was to compare the real-world effectiveness and safety profiles of rosuvastatin and atorvastatin, with a focus on all-cause mortality, major cardiovascular events, and statin-related adverse effects. This was an active comparator cohort study utilizing the target trial emulation research approach. The latter emulates the design of a randomized controlled trial. This study included data from 285,680 adults newly prescribed rosuvastatin or atorvastatin within the CRDS and UKB databases. To limit selection bias, 1:1 multilevel propensity score matching was applied to harmonize characteristics between the two patient groups. After this matching, Cox proportional hazards regressions were used to estimate the primary outcome of all-cause mortality as well as any other adverse events.
• At six years' threshold, 2.57 per 100 person-years and 0.66 per 100 person-years seemed to contrast with 2.83 per 100 person-years and 0.90 per 100 person-years based on the studies of the CRDS database and the UKB database, respectively.
• These corresponded to CI reductions of -1.03% (95% CI, -1.44% to -0.46%) for the CRDS dataset and -1.38% (95% CI, -2.50% to -0.21%) in the UKB dataset.
• The rosuvastatin group also had lower rates of major adverse cardiovascular events and adverse liver outcomes in both the databases, hence a slight edge in protecting heart and liver conditions.
• Patients on rosuvastatin were at a higher risk of type 2 diabetes mellitus compared to that of patients on atorvastatin, with the patients at risk, it would be a problem.
The findings appear to indicate that although rosuvastatin has an edge over atorvastatin regarding a slight mortality benefit, the absolute differences were mostly small. This study contributes to the continuing evaluation of statin alternatives, providing health care professionals with information on slight differences between rosuvastatin and atorvastatin. For patients with a specific risk profile, like heightened susceptibility to diabetes, these results may be able to guide decisions on individualized therapy.
Reference:
Zhou, S., Chen, R., Liu, J., Guo, Z., Su, L., Li, Y., Zhang, X., Luo, F., Gao, Q., Lin, Y., Pang, M., Cao, L., Xu, X., & Nie, S. (2024). Comparative effectiveness and safety of atorvastatin versus rosuvastatin: A multi-database cohort study. Annals of Internal Medicine. https://doi.org/10.7326/m24-0178
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