Statin Wars: The Heavyweight Match-Atorvastatin versus Rosuvastatin for the Treatment of Atherosclerosis, Heart Failure, and Chronic Kidney Disease

James J. DiNicolantonio, Carl J. Lavie, Victor L. Serebruany, James H. O'Keefe

Statins are a standard of care in many clinical settings, especially for dyslipidemia management, and are used for the primary and secondary prevention of cardiovascular disease. Importantly, not all statins are born equal. The statin class consists of a number of heterogenous drugs, which vary in properties such as potency in lowering low-density lipoprotein cholesterol levels, lipophilicity, renoprotection, increasing high-density lipoprotein cholesterol levels, lowering triglyceride levels, and effects on glucose metabolism and myocardial function. It remains unclear whether these differences significantly impact clinical outcomes or if 1 statin should be preferred over another. This review summarizes the properties of the 2 most potent statins available (atorvastatin and rosuvastatin), as well as assesses the comparative experimental and clinical trials that have been conducted on these 2 agents. We believe that the available body of evidence indicates that atorvastatin may have several advantages over rosuvastatin, despite the latter's greater potency, suggesting that atorvastatin should be the potent statin of choice, especially in treating patients with renal impairment or heart failure with concomitant coronary artery disease. The recent availability of atorvastatin as a generic option gives this drug another practical and compelling advantage over rosuvastatin.