Abstract 11740: Role of Physical Fitness in Statin Induced Type II Diabetes Mellitus

Abstract

Introduction: Several studies have now shown statin use predisposes to the development of type II diabetes mellitus (DM). We evaluated high risk Veterans to identify factors influencing the incidence of statin induced DM, Methods: Non-diabetic patients (n= 5143; age: 58.9±10.9 yrs), completed a routine exercise tolerance testing at Washington DC and Palo Alto Veterans Affairs Medical Centers at baseline. All had a normal exercise response. We established five fitness categories based on age-stratified quintiles of peak metabolic equivalents (MET) achieved: Least-fit (4.5±1.1 METs; n= 1007); Low-Fit (6.2±1.1 METs; n=1159); Moderately-Fit (7.3±1.2 METs; n=1061); Fit (8.4±1.1 METs; n=1073) and Highly-Fit (11.0±2.3 METs; n=843). Multivariable Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals [CI] for incidence of DM across fitness categories. The model was adjusted for age, BMI, gender, race, resting blood pressure, hypertension, smoking status and medications. The Least-fit category was the referent. Results: During a follow-up of 10.01 years after initiation of statin therapy, 1110 patients developed DM (21.5 events per 1000 person years of follow-up). The association between fitness status and incidence of DM was inverse and graded. The risk was 8% lower for each 1-MET increase in exercise capacity (HR=0.92, CI: 0.89-0.94). When considering fitness categories, DM risk was similar for individuals in the three lowest fitness categories. However, the risk was 22% lower (HR=0.78; CI: 0.64-0.94) for fit individuals (peak exercise capacity: 8.4±1.1 METs) and 42% lower for those in the highest fitness category (peak exercise capacity: 11.0±2.3 METs; HR= 0.58; CI: 0.46-0.73). Conclusions: High levels of physical fitness were protective against development of statin induced type II DM in this high risk Veteran population.