Statins are among the most commonly used medicines for lowering cholesterol and protecting the heart.
They reduce levels of LDL cholesterol, often called “bad” cholesterol, which can build up inside arteries and increase the risk of heart attacks and strokes.
Rosuvastatin is a powerful statin that is widely prescribed because it can lower cholesterol effectively. However, research from Johns Hopkins University suggests that the drug may carry a slightly higher risk of kidney problems than another widely used statin, atorvastatin.
Concerns about rosuvastatin and the kidneys are not completely new. When the U.S. Food and Drug Administration first approved the medicine, clinical studies had reported blood or protein appearing in the urine of some patients, especially among people taking higher doses.
Blood in the urine can sometimes be a sign of irritation or damage somewhere in the urinary system. Protein in the urine can also be important because healthy kidneys normally prevent large amounts of protein from leaking from the blood into urine.
To examine the issue in everyday medical care, researchers studied electronic health records collected between 2011 and 2019. Their analysis included 152,101 people who started rosuvastatin and 795,799 people who started atorvastatin.
The researchers followed patients for up to three years and compared kidney-related outcomes between the two groups. Among rosuvastatin users, about 2.9% developed blood in the urine and about 1% developed protein in the urine.
Compared with people taking atorvastatin, rosuvastatin users had an 8% higher relative risk of blood in the urine and a 17% higher relative risk of protein in the urine. They also had a 15% higher relative risk of serious kidney failure requiring treatments such as dialysis or a kidney transplant.
The difference was particularly important at higher rosuvastatin doses. People with advanced kidney disease may be more vulnerable because their kidneys already have difficulty filtering waste and medicines from the blood.
The researchers found that nearly half of patients with severe kidney disease were given rosuvastatin doses above the FDA-recommended amount for people with poor kidney function. This finding suggests that closer attention to dosing guidelines could reduce unnecessary risk.
Importantly, the study did not find that rosuvastatin was better than atorvastatin at preventing major heart-related problems. The two medicines provided similar cardiovascular benefits, while rosuvastatin was linked to somewhat greater kidney risks.
The research was led by Dr. Jung-im Shin of Johns Hopkins University and was published in the Journal of the American Society of Nephrology. The findings add useful real-world evidence to earlier concerns about how rosuvastatin may affect the kidneys.
This does not mean that people taking rosuvastatin should suddenly stop using it. Statins can play an important role in preventing heart attacks and strokes, and stopping treatment without medical advice could increase cardiovascular risk.
Instead, people with kidney disease or those taking higher doses of rosuvastatin may want to discuss the findings with their doctor. Doctors can consider kidney function, cholesterol levels, dose, and other health risks when deciding whether rosuvastatin, a lower dose, or another statin is the best choice.
If you care about heart health, please read studies about top 10 foods for a healthy heart, and how to eat right for heart rhythm disorders.
For more health information, please see recent studies about how to eat your way to cleaner arteries, and salt and heart health: does less really mean more?
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