Statin and the risk of new-onset diabetes mellitus

ABSTRACT

Statins are the first choice of pharmacological treatment for dyslipidemia to prevent atherosclerotic cardiovascular disease. Ample evidence demonstrates the benefits and safety of statin, including the lipid-lowering efficacy and the ability to improve clinical prognosis. High-intensity statin therapy is especially recommended in high-risk patients and those with cardiovascular disease. However, clinical trials, meta-analyses, and retrospective analyses have shown 9% to 13% increase in the risk of new-onset diabetes with statin therapy. The risk of new-onset diabetes with statin increased with higher statin doses, and the mechanisms are not yet fully understood. Mendelian randomization studies have suggested that new-onset diabetes with statin may be related to the activity of 3-hydroxy-3-methylglutaryl-coenzyme A reductase or low density lipoprotein receptor. Patients with familial hypercholesterolemia did not show an increased risk of new-onset diabetes with statin compared to their unaffected relatives. Moreover, some studies have shown that different kinds of statins impaired pancreatic beta-cell function. Recently, genetic analysis studies have shown probable associations between changes in several proteins involving lipid metabolism and the increased risk of new-onset diabetes. Statin therapy should be emphasized to prevent and treat atherosclerotic cardiovascular disease on the basis of individual cardiovascular risk and clinical characteristics, especially in high-risk patients, such as those with diabetes. It is important to combine statin therapy with patient education and lifestyle modifications, including diet control, exercise, and weight changes, to manage dyslipidemia and minimize the risk of new-onset diabetes. Statin therapy should be considered more important and the risk of new-onset diabetes with statin should not be overemphasized.