Luis E Cueva-Cañola, Andrea C Beltran-De la Fuente, Diana I Ramírez Navarro, Astrid G Carrión-Cuéllar, Bruno J Navarro-Rondoy, Yerson Alberca-Naira, Bruno Mendoza Castillo, Harold Jimenez-Alvarez, Karoly P Zuñiga-Montaño, Erick N Calvario-Sanchez, Leonardo Rangel-Castilla
Evidence suggests biological differences but is insufficient to establish clinical superiority of either statin.
BACKGROUND AND OBJECTIVE: Acute ischemic stroke (AIS) and transient ischemic attack (TIA) are leading causes of mortality and disability. High-intensity statins are central to secondary prevention, with guidelines recommending atorvastatin or rosuvastatin; however, comparative evidence post-stroke is limited. This study systematically reviewed literature comparing both agents after AIS/TIA.
MATERIAL AND METHODS: The protocol was registered in PROSPERO (CRD420261287374). PubMed, Embase, and Ovid MEDLINE were searched from inception to January 17, 2026, using predefined terms for statins and AIS/TIA.
RESULTS: Five studies were included (one randomized trial and four cohort studies). Compared with atorvastatin, rosuvastatin was associated with greater improvements in lipid and inflammatory markers. Despite these differences, rates of recurrent stroke and all-cause mortality were similar between treatments. However, rosuvastatin was associated with lower rates of hemorrhagic stroke and more favorable composite cardiovascular outcomes.
CONCLUSIONS: Evidence suggests biological differences but is insufficient to establish clinical superiority of either statin.