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Comparative Effectiveness and Safety of Atorvastatin vs Rosuvastatin
TAKE-HOME MESSAGE
- In this target trial emulation study comparing the effectiveness and safety of rosuvastatin with those of atorvastatin, individuals initiating rosuvastatin for primary or secondary prevention had a slightly lower risk of all-cause death, major adverse cardiovascular events, and major adverse liver outcomes but a higher risk of incident type 2 diabetes than propensity score–matched individuals initiating atorvastatin.
- These findings suggest that, although rosuvastatin may offer a modest benefit in reducing mortality and cardiovascular risks compared with atorvastatin, further evidence is needed to confirm these outcomes.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Rosuvastatin and atorvastatin are the most widely prescribed moderate- to high-intensity statins. However, evidence on their efficacy and safety during actual use is limited.
OBJECTIVE
To compare the real-world effectiveness and safety of rosuvastatin and atorvastatin.
DESIGN
Active comparator cohort study using target trial emulation.
SETTING
The China Renal Data System (CRDS) and UK Biobank (UKB) databases.
PARTICIPANTS
Adults newly prescribed rosuvastatin or atorvastatin.
MEASUREMENTS
The primary outcome was all-cause mortality. Cox proportional hazards regressions were used after 1:1 multilevel propensity score matching.
RESULTS
Among the 285 680 eligible participants in both databases, 6-year all-cause mortality was lower for rosuvastatin than for atorvastatin (2.57 vs. 2.83 per 100 person-years in the CRDS database and 0.66 vs. 0.90 per 100 person-years in the UKB database), with differences in cumulative incidence of -1.03% (95% CI, -1.44% to -0.46%) in the CRDS database and -1.38% (CI, -2.50% to -0.21%) in the UKB database. For secondary outcomes in both databases, rosuvastatin conferred lower risks for major adverse cardiovascular events and major adverse liver outcomes. In the UKB database, the risk for development of type 2 diabetes mellitus was higher with rosuvastatin, and the 2 medications carried similar risks for development of chronic kidney disease and other statin-related adverse effects.
LIMITATION
Possible residual confounding.
CONCLUSION
This study found differences in risks for some important outcomes associated with rosuvastatin and atorvastatin. The differences were relatively small, and many did not meet traditional standards for statistical significance. Further research is needed to understand whether these findings can be used with confidence in clinical practice.
PRIMARY FUNDING SOURCE
National Key R&D Program of China and National Natural Science Foundation of China.
Additional Info
Comparative Effectiveness and Safety of Atorvastatin Versus Rosuvastatin : A Multi-database Cohort Study
Ann. Intern. Med 2024 Oct 29;[EPub Ahead of Print], S Zhou, R Chen, J Liu, Z Guo, L Su, Y Li, X Zhang, F Luo, Q Gao, Y Lin, M Pang, L Cao, X Xu, S NieFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.