Rosuvastatin has been marketed for approximately a decade. In this review we 
critically discuss available evidence on the benefits and risks from its use. In 
clinical trials using rosuvastatin, 'lowest is best' was relevant for 
on-treatment low-density lipoprotein cholesterol levels. Targeting levels 
<50 mg/dl was associated with the greatest decrease in vascular 
morbidity/mortality in the primary prevention setting. Also, such reduction can 
induce atherosclerosis regression without increasing the risk of adverse 
effects. Pooled data suggest that the safety profile of rosuvastatin is not 
different from that of other statins. It was estimated that 
rosuvastatin-associated absolute hazards of muscle-, liver- and renal-related 
adverse effects are lower than the corresponding vascular benefits in moderate 
vascular risk individuals. However, these data are subject to biases and need 
confirmation on a prospective basis. Significant liver enzyme elevations are 
rare. These often imply underlying non-alcoholic fatty liver disease (NAFLD), 
which is associated with increased vascular risk. Rosuvastatin can improve 
biochemical biomarkers and histological score of NAFLD. Whether this benefit is 
associated with vascular risk reduction should be assessed by prospective 
studies. Both chronic kidney disease and albuminuria independently predict 
vascular morbidity and mortality. Rosuvastatin improved the estimated glomerular 
filtration rate and decreased albuminuria in patients with moderately impaired 
kidney function. Also, vascular morbidity and mortality might be reduced in 
these patients. The same was not relevant in end-stage renal disease. 
Rosuvastatin-induced proteinuria appears to be of tubular origin, not relating 
to kidney injury. Rosuvastatin increases the risk of new-onset diabetes by 
dose-dependently impairing insulin sensitivity. Obese individuals with 
prediabetes appear to be predominantly affected. However, absolute vascular 
benefits of rosuvastatin may counterbalance this risk. Rosuvastatin is effective 
for the prevention and management of atherosclerotic vascular disease. 
Individualization of its use can maximize benefits and reduce the risk of 
adverse effects.