Coronary artery disease (CAD) is a type of heart disease that affacts the coronary arteries, usually leading to angina due of reduced blood flow, nutrition delivery, and oxgyen supply to the cardiac muscle. For CAD patients, intensive statin therapy to reduce low-density lipoprotein cholesterol (LDL-C) is recommended.
Previous meta-analysis have shown that new-onset diabetes mellitus (NODM) more frequently developed in patients receiving high-intensity statin therapy compared to those who on lower-intensity statin treatment. Rosuvastatin and atorvastatin are two common medications frequently used for high-intensity statin therapy. However, no direct comparsons has been conducted between Rosuvastatin and atorvastatin in the incidence of NODM.
In this post-hoc analysis of the LODESTAR trial, they evaluated whether there was a difference between rosuvastain and atorvastin in the incidence of NODM in patients receiving high-intensity stain therapy in a head-to-head comparison.
In this study, patients were randomly assigned to receive either rosuvastatin or atorvastatin in a 1:1 manner. In addition, patients were also assigned to receive a statin using either targeted strategy (treat-to-target group) or fixed strategy (high-intensity statin group).
In treat-to-target group, a statin dose changed along with LDL-C levels
- When LDL-C ≧ 70 mg/dL, the initial statin dose was up-titrated.
- When 70 > LDL-C ≧ 50 mg/dL, the statin dose remained.
- When LDL-C ≦ 50 mg/dL, the initial statin dose was down-titrated.
Over the 3-year follow-up, as-treated group with rosuvastatin had a higher number of NODM incidence compared to the atorvastatin group, but the difference was not statistically significant. However, when the achieved LDL-C level was ≦ 70 mg/dL, the risk of NODM in rosuvastatin group significantly increased compared to atorvastatin group.
This study provided a hint that the risk of NODM associated with different statin types may be partly attributed to the LDL-C lowering effects, and also offered evidence for statin selection for patients receiving high-intensity statin therapy. However, the detailed mechanism underlying the association between NODM incidence and statin still remains unclear.
Reference
- Hong, S. J., Lee, Y. J., Kang, W. C., Hong, B. K., Lee, J. Y., Lee, J. B., Yang, T. H., Yoon, J., Lee, S. J., Ahn, C. M., Kim, J. S., Kim, B. K., Ko, Y. G., Choi, D., Jang, Y., Hong, M. K., & LODESTAR investigators (2024). Effect of rosuvastatin versus atorvastatin on new-onset diabetes mellitus in patients treated with high-intensity statin therapy for coronary artery disease: a post-hoc analysis from the LODESTAR randomized clinical trial. Cardiovascular diabetology, 23(1), 287. https://doi.org/10.1186/s12933-024-02386-w
