Rosuvastatin Versus Atorvastatin for Cardiovascular Disease Risk in Patients with Type 2 Diabetes: A Korean Cohort Study

<b>Background</b>: Rosuvastatin and atorvastatin are indicated for cardiovascular protection in patients with type 2 diabetes (T2D) but may differ in clinical effectiveness and safety. This study compared real-world cardiovascular and safety outcomes associated with rosuvastatin versus atorvastatin in patients with T2D, with an emphasis on older adults. <b>Methods</b>: This retrospective cohort study used electronic health records from 10 Korean hospitals standardized to the Common Data Model. Adults (≥18 years) with T2D who were newly prescribed rosuvastatin or atorvastatin were included. After propensity score matching, primary outcomes (myocardial infarction [MI], heart failure, stroke, cardiac arrest, and in-hospital death), secondary outcomes (peripheral arterial disease [PAD] and glaucoma), and safety outcomes (acute kidney injury, cataract, and myalgia) were compared. Subgroup and sensitivity analyses were conducted among patients aged ≥65 years. <b>Results</b>: Among 49,034 patients (rosuvastatin, 16,123; atorvastatin, 32,911), baseline characteristics were well balanced. Across all participating hospitals, the comparative analyses showed no meaningful differences in cardiovascular or safety outcomes between the two statins. However, among patients aged ≥65 years, rosuvastatin was associated with a higher risk of PAD (hazard ratio [HR] 1.19; 95% confidence interval [CI] 1.03-1.38), and this finding was consistent in sensitivity analysis (HR 1.31; 95% CI 1.01-1.70). <b>Conclusions</b>: Rosuvastatin and atorvastatin demonstrated comparable cardiovascular effectiveness and safety. Although rosuvastatin was associated with a modestly higher incidence of PAD in older adults, the difference was small. From a clinical perspective, these findings underscore the importance of individualized statin therapy tailored to patient-specific factors such as age, comorbidity, and vascular health. Overall, both statins provide overall therapeutic equivalence for cardiovascular prevention.