Re: Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial

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Dear Editor

Lee et al. reported the effect of statins on cardiovascular outcomes and mortality (1). They also reported the risk of diabetes mellitus (DM) by statin use. I present comments on this study.

Kohli et al. evaluated DM risk by statins with special reference to the glucose impairment status (2). During the five-year follow-up, 2.9% of subjects with no DM (healthy) and 14.2% of subjects with pre-DM developed DM. In addition, high-intensity statins were associated with a higher risk of incident DM if the subjects had pre-DM. In contrast, healthy subjects had no risk of DM when taking high-intensity statins. Furthermore, subjects with pre-DM had a higher risk of cardiovascular outcomes than the healthy subjects. These findings indicated that mild impairment of glucose metabolism might be a risk factor for DM by statin use.

Regarding statin types, DM risk in pitavastatin use was lower than that in atorvastatin (3), which was supported by a meta-analysis (4). There was no dose-response relationship in the risk of incident DM by statin use (5), and additional risk assessment with types and doses of statins is required.

Finally, a meta-analysis showed that sodium-glucose transporter-2 inhibitors significantly reduced DM incidence in subjects with pre-DM (6). Polypharmacy is common in older subjects. Appropriate adjustments of several medications to manage DM risk may be required. Nevertheless, the efficacy and safety of statin use should be comprehensively evaluated in randomized controlled trials.

References
1. Lee YJ, Hong SJ, Kang WC, et al. Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial. BMJ 2023;383:e075837.
2. Kohli P, Waters DD, Nemr R, et al. Risk of new-onset diabetes and cardiovascular risk reduction from high-dose statin therapy in pre-diabetics and non-pre-diabetics: an analysis from TNT and IDEAL. J Am Coll Cardiol 2015;65(4):402-404.
3. Mita T, Nakayama S, Abe H, et al. Comparison of effects of pitavastatin and atorvastatin on glucose metabolism in type 2 diabetic patients with hypercholesterolemia. J Diabetes Investig 2013;4(3):297-303.
4. Cai T, Abel L, Langford O, et al. Associations between statins and adverse events in primary prevention of cardiovascular disease: systematic review with pairwise, network, and dose-response meta-analyses. BMJ 2021;374:n1537.
5. Lee HY, Han KH, Chung WB, et al. Safety and efficacy of pitavastatin in patients with impaired fasting glucose and hyperlipidemia: A randomized, open-labeled, multicentered, phase IV study. Clin Ther 2020;42(10):2036-2048.
6. Singh AK, Singh A, Singh R. New-onset diabetes with sodium-glucose cotransporter-2 inhibitors in prediabetes: An updated meta-analysis and possible mechanisms. Diabetes Metab Syndr 2023;17(6):102789.

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Electronic Publication Date: 
Friday, November 24, 2023 – 04:41
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Re: Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial

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Last Name: 
Tomoyuki
First name and middle initial: 
Kawada
Address: 
Sendagi 1-1-5, Bunkyo-ku, Tokyo, Japan
Occupation: 
Professor
Affiliation: 
Nippon Medical School
BMJ: Additional Article Info: 
Rapid response

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