Cerivastatin best for total cholesterol, simvastatin for LDL-C in DKD with hyperlipidemia

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Frontiers in Medicine Published May 29, 2026 Medically reviewed May 29, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider cerivastatin for TC and simvastatin for LDL-C reduction in DKD with hyperlipidemia, but interpret cautiously.

This Bayesian network meta-analysis of 20 randomized controlled trials evaluated the comparative efficacy of lipid-lowering therapies (cerivastatin, simvastatin, atorvastatin, rosuvastatin, fenofibrate) in patients with diabetic kidney disease (DKD) and hyperlipidemia. The analysis focused on multiple outcomes including total cholesterol (TC), LDL-C, urine albumin-to-creatinine ratio (UACR), and cardiovascular event rate (CVER).

For TC reduction, cerivastatin showed the greatest effect (mean difference [MD] -94.03, 95% CI -185.37 to -2.16). Simvastatin was most effective for lowering LDL-C (MD -56.05, 95% CI -101.64 to -11.66). Atorvastatin, rosuvastatin, and fenofibrate potentially improved UACR, though no effect size or confidence interval was reported for this outcome. For CVER, atorvastatin (MD -3.19, 95% CI -5.12 to -1.27) and fenofibrate (MD -1.44, 95% CI -2.78 to -0.09) most robustly reduced cardiovascular events.

Limitations of the analysis were not reported, and the certainty of evidence is based on a Bayesian network meta-analysis with confidence intervals. The authors note that the findings support a phenotype-driven cardiovascular risk management strategy prioritizing residual cardiovascular risk reduction. However, comparative efficacy beyond reported outcomes should not be inferred, and the clinical significance of UACR improvement remains unclear without an effect size.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundIn diabetic kidney disease (DKD), dyslipidemia accelerates renal decline and heart failure risk, making Cardio-Renal-Metabolic (CRM) risk reduction critical. The bidirectional relationship between cardiac and renal dysfunction further highlights the necessity of lipid-lowering therapy as a common intervention pathway; however, its comparative efficacy remains unclear.ObjectiveTo compare the Cardio-Renal-Metabolic (CRM) outcomes of various lipid-lowering agents.MethodsWe searched PubMed, Embase, Web of Science, and Cochrane Library for Randomized Controlled Trials (RCTs) up to May 10, 2025; a Bayesian network meta-analysis compared their effects.ResultsFrom 20 RCTs, Cerivastatin best reduced Total Cholesterol (TC) (Mean Difference (MD): -94.03, 95% CI: -185.37 to -2.16), while Simvastatin best lowered Low-Density Lipoprotein Cholesterol (LDL-C) (MD: -56.05, 95% CI: -101.64 to -11.66). For cardiorenal outcomes, Atorvastatin, Rosuvastatin, and Fenofibrate potentially improved Urine Albumin-to-Creatinine Ratio (UACR). Atorvastatin (MD: -3.19, 95% CI: -5.12 to -1.27) and Fenofibrate (MD: -1.44, 95% CI: -2.78 to -0.09) most robustly reduced cardiovascular event rates (CVER) in hyperlipidemic DKD.ConclusionLipid-lowering agents have divergent effects; Atorvastatin and Fenofibrate best reduce CVER despite variable renal effects, supporting a phenotype-driven CRM strategy prioritizing residual cardiovascular risk reduction.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/, identifier CRD420251049719.