Risk of diabetes in patients treated with HMG- CoA reductase inhibitors

Abstract

Risk of Diabetes in Patients Treated withHMG-CoA Reductase InhibitorsYongin ChoDepartment of MedicineThe Graduate School, Yonsei University(Directed by Professor Eun Seok Kang)Inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase (statins) are used to control blood cholesterol levels and reduce cardiovascular disease. It has been repeatedly reported that statins may cause new-onset diabetes mellitus (DM). However, limited evidence exists from direct head to head comparisons of statins on whether the risk of DM differs among statins. We investigated the risk of development of new-onset diabetes in subjects treated with different statins.Our study enrolled 1,160 patients without DM or impaired fasting glucose (IFG) who were receiving statin treatment for cholesterol control. We evaluated the incidence of new-onset diabetes according to the type of statin. The mean duration of follow-up was 54.6 ± 10.6 months. The incidence of DM was significantly higher in the pitavastatin group (10.7%) compared to that in the other statin groups [atorvastatin (4.0%), rosuvastatin (6.1%), simvastatin (4.1%), and pravastatin (3.7%); p=0.003]. The risk of diabetes was the highest in the pitavastatin group compared with that in the atorvastatin group [hazard ratio (HR)=2.68, p=0.004]. Other statins showed no significant risk differences compared to that for atorvastatin. Fasting blood glucose level at baseline was associated with the development of diabetes (HR=1.06, p=0.031). Other factors including age, gender, body-mass index, duration of statin use, and total cholesterol level at baseline showed no association with the development of DM.Among the five statins, pitavastatin showed the strongest effect on the development of new-onset diabetes.