Introduction: Rosuvastatin compared with atorvastatin has been associated with worse renal outcomes in people with diabetes and chronic kidney disease (CKD). There are interethnic differences in statin metabolism and dosage. We compared the risk associations of rosuvastatin and atorvastatin with risk of cardiorenal outcomes in Chinese people with diabetes across varying renal functions.

Methods: We conducted a population-based analysis of 95,713 new users of atorvastatin (n=83,962) and rosuvastatin (n=11,751) in people with diabetes in 2002-2019, followed up until December 31, 2019 in the Hong Kong Hospital Authority. We used Cox-model with time-dependent exposure and covariates to estimate the hazard ratio (HR) of end-stage kidney disease (ESKD), major adverse cardiovascular events (MACE), and death in a propensity-score overlap-weighted cohort stratified by CKD stage. Dose effects on outcomes were also estimated.

Results: Of 95,713 patients with diabetes (mean age: 65.1±11.4 years, median diabetes duration: 5.0 [IQR: 2.0-9.0] years), 76.7%, 20.1%, and 3.2% were in CKD stages G1-2, G3, and G4, respectively. Nearly one-fifth of patients at CKD stage G4 were prescribed rosuvastatin at 20mg or above daily. During a median follow-up of 2.4 years, 3.13%, 4.75%, and 8.43%% had incident ESKD, MACE, and death, respectively. Compared with atorvastatin, rosuvastatin was associated with neutral risk of ESKD (adjusted and weighted HR=1.00, 95%CI: 0.89-1.12), and death (HR=0.92, 0.83-1.01), but a lower risk of MACE (HR=0.86, 0.77-0.95). At comparable intensity (rosuvastatin 5-10 mg versus atorvastatin 10-20 mg), rosuvastatin was associated with neutral risk of ESKD and death, but a lower risk of MACE in CKD stages G1-2 (HR=0.69, 0.56-0.86), and G3 (HR=0.72, 0.55-0.95).

Conclusions: In Chinese people with diabetes, compared with atorvastatin, use of rosuvastatin was associated with neutral risk of ESKD and mortality, but a lower risk of MACE.

Disclosure

Y. Huang: None. A. Yang: None. M. Shi: None. H. Wu: None. T. Chen: None. C. Ke: Advisory Panel; Sanofi. Speaker's Bureau; AstraZeneca. J.N.M. Lui: None. A.P. Kong: Speaker's Bureau; Abbott. Advisory Panel; Merck Sharp & Dohme Corp. Speaker's Bureau; Boehringer-Ingelheim, Bayer Inc., AstraZeneca. Other Relationship; Dexcom, Inc. Speaker's Bureau; Eli Lilly and Company, Novo Nordisk, Sanofi. Advisory Panel; Kyowa Kirin Co., Ltd., Abbott. R.C. Ma: Advisory Panel; AstraZeneca. Other Relationship; Bayer Inc., Boehringer-Ingelheim. Advisory Panel; Merck & Co., Inc. Other Relationship; Roche Diagnostics, Novo Nordisk. Advisory Panel; Takeda Pharmaceutical Company Limited. Other Relationship; GemVCare Ltd. A. Luk: Research Support; Novo Nordisk, Amgen Inc., Merck Sharp & Dohme Corp., Roche Pharmaceuticals, Biogen, Boehringer-Ingelheim, Shanghai Junshi Biosciences CO.Ltd. J.C. Chan: Research Support; AstraZeneca, Hua Medicine. Consultant; Sanofi. Research Support; Servier Laboratories. Consultant; Viatris Inc. Research Support; Merck & Co., Inc. Stock/Shareholder; GemVCare Ltd. Board Member; Asia Diabetes Foundation. Speaker's Bureau; Zuellig Pharma Holdings Pte. Ltd. Advisory Panel; Bayer Inc. Speaker's Bureau; Boehringer-Ingelheim. E. Chow: Research Support; Merck KGaA. Speaker's Bureau; AstraZeneca. Advisory Panel; Boehringer-Ingelheim. Research Support; Medtronic. Speaker's Bureau; Zuellig Pharma Holdings Pte. Ltd., Abbott.

Funding

CUHK Impact Research Fellowship Scheme

© 2024 by the American Diabetes Association
2024
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