Abstract
BackgroundIncreasing evidence suggest that statin therapy has a diabetogenic effect. Individual types of statin may have a different effect on glucose metabolism. Using the repeated nationwide population-based health screening data in Korea, we investigated the longitudinal changes in fasting glucose level of non-diabetic individuals by use of statins.MethodsFrom the National Health Screening Cohort, we included 379,865 non-diabetic individuals who had ≥ 2 health screening examinations with fasting blood glucose level measured in 2002–2013. Using the prescription records of statins in the database, we calculated the proportion of days covered (PDC) and average number of defined daily doses per day (anDDD) by statins. We constructed multivariate linear mixed models to evaluate the effects of statins on the changes in fasting glucose (Δglu).ResultsHigh PDC by statins had a significant positive effect on Δglu (coefficient for PDC 0.093 mmol/L, standard error 0.007, p < 0.001). anDDD by statins was also positively associated with Δglu (coefficient for anDDD 0.119 mmol/L, standard error 0.009, p < 0.001). Unlike statins, the PDC by fibrate and ezetimibe were not significantly associated with Δglu. There was no significant interaction effect on Δglu between time interval and statin. Considering individual types of statins, use of atorvastatin, rosuvastatin, pitavastatin, and simvastatin were significantly associated with increase of Δglu. Pravastatin, lovastatin, and fluvastatin were also positively associated with Δglu, but were not statistically significant.ConclusionsMore adherent and intensive use of statins was significantly associated with an increase in fasting glucose of non-diabetic individuals. In subgroup analysis of individual statins, use of atorvastatin, rosuvastatin, pitavastatin and simvastatin had significant association with increase in fasting glucose. Pravastatin, lovastatin, and fluvastatin had non-significant trend toward an increased fasting glucose. Our findings suggest the medication class effect of statins inducing hyperglycemia.
Highlights
Increasing evidence suggest that statin therapy has a diabetogenic effect
Subjects According to the inclusion and exclusion criteria, we included 379,865 non-diabetic subjects who received ≥ 2 measurements of fasting glucose level (Fig. 1)
When we performed analysis including anDDD in place of proportion of days covered (PDC) as a marker of statin intensity, anDDD by statins was positively associated with changes in fasting glucose (Δglu)
Summary
Increasing evidence suggest that statin therapy has a diabetogenic effect. Individual types of statin may have a different effect on glucose metabolism. Using the repeated nationwide population-based health screen‐ ing data in Korea, we investigated the longitudinal changes in fasting glucose level of non-diabetic individuals by use of statins. 3-hydroxy-3-methylglutaryl-coenzyme reductase (HMGCR) inhibitors, are class of lipid lowering medications with pleiotropic properties due to anti-inflammatory, anti-thrombotic, and anti-oxidative effects [1] It is well-established that statins can reduce the risk for cardiovascular and cerebrovascular diseases [2]. The individual statin types may have different effects on glucose metabolism [13, 14] To investigate these issues, we conducted a longitudinal study to analyze the changes in fasting glucose by use of statins based on data from repeatedly performed nationwide health examinations in Korea
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