Risk of new-onset diabetes mellitus during treatment with low-dose statins in Japan: A retrospective cohort study

The use of statins are associated with an increased risk of new-onset diabetes in patients with hypertension and obstructive sleep apnoea, a longitudinal study

BACKGROUND

Statins, a kind of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, are first-line cholesterol-lowering drugs that are widely used in the primary and secondary prevention of coronary atherosclerotic heart disease (CAD). However, the safety of statins has been in the spotlight as recent studies have shown that statins may increase the incidence of diabetes. Therefore, we conducted a study of statins use and new-onset diabetes(NODM) in people with hypertension and obstructive sleep apnea (OSA) to better understand the relationship and to provide guidance for future clinical management.

METHODS

We conducted a retrospective cohort study using data from the Urumchi Hypertension Database (UHDATA), including patients aged ≥ 18 years diagnosed with hypertension and obstructive sleep apnoea treated at our Hypertension Centre between 2015 and 2019. The study was followed until November 2023 and the primary endpoint was new onset diabetes during the follow-up period. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Cox proportional hazards model. Sensitivity analyses were performed by excluding those with pre-diabetes at baseline.

RESULTS

8755 patients with hypertension and OSA, and 80.1% were followed up. During median follow-up of 31 months, 740 patients developed NODM. The incidence of NODM per 1000 person-years was 53.1. In Cox regression analysis, the risk of diabetes is significantly higher in patients who continue to take statins (HR = 1.77, 95% CI, 1.34-2.34, P < 0.001), and the results remain significant in sensitive analysis.

CONCLUSIONS

In patients with OSA and hypertension, continuous statins use increases the risk of diabetes and physicians should be vigilant about monitoring blood glucose levels when using statins in this patients.

Risk of new onset diabetes mellitus with pitavastatin as compared to atorvastatin and rosuvastatin: a systematic review and meta-analysis

BACKGROUND

Statins are linked to the risk of new-onset diabetes mellitus (NODM). While atorvastatin and rosuvastatin are often associated with NODM, pitavastatin may carry a lower risk. This systematic review and meta-analysis (SRMA) evaluated the impact of pitavastatin on NODM compared to atorvastatin and rosuvastatin.

METHODS

We conducted a systematic literature search using PubMed, CENTRAL, EMBASE, and ClinicalTrials.gov. Two authors independently screened studies, assessed the risk of bias using Joanna Briggs Institute, Newcastle-Ottawa, and Scottish Intercollegiate Guidelines Network checklists, and extracted data. The analysis was performed using RevMan 5.4.1, and results were represented as risk ratios (RR) with 95% confidence intervals (CI) and heterogeneity was evaluated using the I2 statistic.

RESULTS

Of 517 records screened, 13 studies were included, comprising observational studies, and randomized controlled trials. Most of the studies showed pitavastatin to be associated with a lower or no risk of NODM. Meta-analysis revealed that pitavastatin had a lower risk of NODM compared to atorvastatin (RR = 0.86, 95% CI = 0.79-0.93, p = 0.0002) and rosuvastatin (RR = 0.77, 95% CI = 0.71-0.84, p < 0.00001).

CONCLUSION

Pitavastatin poses a lower risk of NODM than other statins, making it a potentially safer option for patients requiring long-term statin therapy.

PROTOCOL REGISTRATION

www.crd.york.ac.uk/prospero identifier is CRD42022371741.

LDL, LDL receptors, and PCSK9 as modulators of the risk for type 2 diabetes: a focus on white adipose tissue

Type 2 diabetes (T2D) and cardiovascular disease (CVD) share many risk factors such as obesity, unhealthy lifestyle, and metabolic syndrome, whose accumulation over years leads to disease onset. However, while lowering plasma low-density lipoprotein cholesterol (LDLC) is cardio-protective, novel evidence have recognised a role for common LDLC-lowering variants (e.g. in HMGCR, PCSK9, and LDLR) and widely used hypocholesterolemic drugs that mimic the effects of some of these variants (statins) in higher risk for T2D. As these conditions decrease plasma LDLC by increasing tissue-uptake of LDL, a role for LDL receptor (LDLR) pathway was proposed. While underlying mechanisms remain to be fully elucidated, work from our lab reported that native LDL directly provoke the dysfunction of human white adipose tissue (WAT) and the activation of WAT NLRP3 (Nucleotide-binding domain and Leucine-rich repeat Receptor, containing a Pyrin domain 3) inflammasome, which play a major role in the etiology of T2D. However, while elevated plasma numbers of apolipoprotein B (apoB)-containing lipoproteins (measured as apoB, mostly as LDL) is associated with WAT dysfunction and related risk factors for T2D in our cohort, this relation was strengthened in regression analysis by lower plasma proprotein convertase subtilisin/kexin type 9 (PCSK9). This supports a central role for upregulated pathway of LDLR and/or other receptors regulated by PCSK9 such as cluster of differentiation 36 (CD36) in LDL-induced anomalies. Targeting receptor-mediated uptake of LDL into WAT may reduce WAT inflammation, WAT dysfunction, and related risk for T2D without increasing the risk for CVD.

Medications affecting the biochemical conversion to type 2 diabetes: A systematic review and meta-analysis

BACKGROUND

The extent to which some pharmacological interventions reduce or increase the risk of biochemical conversion to T2DM in at-risk individuals is unclear.

METHODS

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus through August 24, 2017, for randomized controlled trials evaluating the effect of drugs suspected to modify the risk of biochemical conversion to T2DM.

RESULTS

We included 43 trials with 192,156 subjects (mean age 60 years; 56% men; mean BMI 30.4 kg/m2). Alpha-glucosidase inhibitors, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, metformin, orlistat, phentermine-topiramate and pioglitazone significantly reduced the risk of biochemical conversion to T2DM, whereas statins and nateglinide increased the risk. There was insufficient direct evidence regarding the effects of sulfonylureas, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter-2 inhibitors. Most trials were brief and evaluated this outcome during treatment without a withdrawal or washout period.

CONCLUSIONS

Several drugs modify the risk of biochemical conversation to T2DM, although whether this effect is persistent and clinically relevant is unclear. Future studies need to focus on cardiovascular disease prevention, mortality and patient-important outcomes instead of biochemical conversion to T2DM.