- Two major statins—rosuvastatin and atorvastatin—are equally effective at reducing heart attacks, strokes, and all-cause deaths, a new study has found.
- The findings indicate that rosuvastatin lowers cholesterol a bit more than atorvastatin but also carries a higher risk of developing diabetes and cataracts.
- Only a third of the study’s participants were women, so their risk in taking these statins will have to be the subject of future research.
The two most powerful statins prescribed for coronary heart disease are rosuvastatin and atorvastatin. Both are equally effective at reducing the likelihood of strokes, heart attacks, and mortality, according to a new study. The two drugs, however, differ in a couple of critical respects.
Rosuvastatin appears to do a better job at lowering cholesterol levels, but is associated with an increased risk of diabetes and cataracts.
Lowering LDL cholesterol levels — “bad” cholesterol — is an important therapeutic goal in the treatment of coronary heart disease, and rosuvastatin may thus be the statin of choice for many.
For people considered at risk of diabetes, though, atorvastatin may provide the safer option.
The study involved 4,400 people in a trial that was conducted at 12 hospitals throughout South Korea. Participants were divided into two groups, each of which was administered either rosuvastatin or atorvastatin between September 2016 and November 2019. In the end, 4,341 individuals completed the trial.
The mean age of participants was 65, with a standard deviation of 10 years, and 27.9% were women.
The study is published in The BMJ.
The primary outcomes in which researchers were interested were heart attack, stroke, all-cause death, and the need for coronary revascularization, in which a person’s blood flow to an area of the heart must be restored. For all of these, the two statins performed roughly equally.
About 1.5% of the rosuvastatin group and 1.2% of the atorvastatin group experienced heart attacks. Approximately 1.1% and 0.9% of the two groups, respectively, experienced stroke. For 2.6% and 2.3% of both groups, researchers recorded all-cause deaths. Around 5.3% versus 5.2% of the groups needed coronary revascularization.
The authors of the study were also concerned about safety, tracking incidents of new-onset diabetes, heart-failure hospital admissions, pulmonary thromboembolism or
The rosuvastatin group was more likely, 7.2%, to develop type 2 diabetes than the atorvastatin group, 5.3%. They were also more likely to require cataract surgery, 2.5% versus 1.5%.
“Although there were small differences between the two statins regarding diabetes and cataract, the differences were all statistically significant,” the study’s senior investigator, Dr. Myeong-Ki Hong, professor of cardiology at the Yonsei University College of Medicine, told Medical News Today.
“In a head-to-head consideration of a patient’s medical profile and risk reduction strategies, it would likely be a factor,” said Dr. Jayne Morgan, cardiologist and executive director of health and community education at the Piedmont Healthcare Corporation in Atlanta, GA, who was not involved in the study.
Prof. Hong noted that these two outcomes were not entirely surprising, as an earlier study had also observed an increase in diabetes with rosuvastatin, and another noted an increase in cataract surgeries.
On the plus side, for the rosuvastatin group, their LDL cholesterol levels were lower than the atorvastatin group, 1.8 to 1.9 mmol/L, respectively.
“Careful interpretation is required toward our study findings. Our study does not support [a] certain type of statin over the other statin. We want to emphasize that while the cardiovascular benefits between the two potent statin types were comparable, each statin has different strengths and weaknesses regarding LDL-cholesterol lowering, new-onset diabetes, and cataracts.”
— Prof. Myeong-Ki Hong
Statins, originally from fungi, are widely prescribed for lowering cholesterol and preventing coronary heart disease.
Their use has skyrocketed 149% since 2013, according to a 2023 study. It is
“Statins can both reduce and retard the deposition of atherosclerotic plaques in the coronary arteries. This decreases buildup and the likelihood of occlusion of critical coronary arteries feeding oxygen to the heart, and therefore decreases the risk of heart attacks.”
— Dr. Jayne Morgan
Exactly how statins keep arteries healthy is not well understood, although a
The study asserts that statins prevent tightly bundled DNA, called chromatin, in endothelial cells that line blood vessels from being loosened by a protein, YAP, that would otherwise lead to changes in gene expression that cause them to transform into less flexible and functional mesenchymal cells.
“Diabetes itself can lead to structural changes in the lens of the eye that can then lead to cataracts,” said Dr. Morgan. “This is because of the duration of exposure of the eye to high levels of blood glucose/ sugar over time.”
“In fact, diabetic retinopathy is a well-known complication of diabetics that can cause blindness. While cataracts are an inevitable part of aging for many, diabetics have an accelerated development of cataracts at a younger age that leads to a build-up of deposits on the eye’s lens.”
— Dr. Jayne Morgan
“Our study provides insights for the importance of meticulous monitoring and appropriate lifestyle interventions to mitigate the risk of new-onset diabetes or cataracts in patients with coronary artery disease when using rosuvastatin over atorvastatin,” Prof. Hong said.
Dr. Morgan said some limitations in the study give her pause. First, it includes only East Asian people from Korea, with no representation of other racial groups.
She also stressed that only a third of the participants were women and their ages are unclear from the study.
“Elevated lipids are an established risk factor for heart disease. Heart disease is the number one killer of women worldwide, and the incidence of
Dr. Morgan also pointed out that the study also did not track osteoporosis in menopausal women.
“Moreover, cholesterol-lowering drugs, and statins in particular, may have either a benefit — or a risk — to the menopausal woman of developing osteoporosis, depending on the dose,” she said.