Annals of Internal MedicineComparative Effectiveness and Safety of Atorvastatin Versus Rosuvastatin: A Multi-database Cohort Study

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A large-scale cohort study comparing rosuvastatin and atorvastatin across two major databases (China Renal Data System and UK Biobank) provides new data on real-world effectiveness and safety profiles of these commonly prescribed statins. The research analyzed outcomes in 285,680 adults, focusing on mortality rates and key adverse events.

Study Design:

• Multi-database cohort study using target trial emulation
• Databases: China Renal Data System (CRDS) and UK Biobank (UKB)
• Population: Adult patients newly prescribed rosuvastatin or atorvastatin
• Analysis: 1:1 multilevel propensity score matching with Cox proportional hazards regressions
• Primary outcome measure: All-cause mortality
• Follow-up period: 6 years

Key Findings:

• Lower all-cause mortality with rosuvastatin vs. atorvastatin:
  • CRDS: 2.57 vs. 2.83 per 100 person-years
  • UKB: 0.66 vs. 0.90 per 100 person-years
• Cumulative incidence difference:
  • CRDS: -1.03% (95% CI, -1.44% to -0.46%)
  • UKB: -1.38% (CI, -2.50% to -0.21%)
• Secondary outcomes:
  • Reduced risk of major adverse cardiovascular events with rosuvastatin
  • Lower risk of major adverse liver outcomes with rosuvastatin
  • Higher risk of type 2 diabetes mellitus with rosuvastatin (UKB database)
  • Similar risks for chronic kidney disease between medications

HCN Medical Memo
Although the study suggests modest advantages for rosuvastatin in mortality and cardiovascular outcomes, the clinical significance of these small differences should be weighed against individual patient factors, including diabetes risk and cost considerations. Both medications maintain strong safety profiles for standard clinical use.

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