High-Intensity Statin Therapy Shows No Diabetes Difference for CAD Patients, LDL-C Impacts Outcome: LODESTAR Trial Analysis

"A difference in the effect of statin type on NODM was noted when LDL-C levels were reduced to below 70 mg/dL," the researchers wrote in Cardiovascular Diabetology.

The impact of rosuvastatin compared to atorvastatin on new-onset diabetes mellitus in patients undergoing high-intensity statin therapy for coronary artery disease (CAD) has yet to be fully understood. Myeong-Ki Hong, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea, and colleagues aimed to evaluate the risk of NODM in patients with CAD treated with rosuvastatin compared to atorvastatin in the randomized LODESTAR trial.

In the LODESTAR trial, CAD patients were randomly assigned to receive either rosuvastatin or atorvastatin through a 2-by-2 factorial design. This post-hoc analysis compared the 3-year incidence of NODM between the two treatments in the as-treated population, focusing specifically on those undergoing high-intensity statin therapy.

The study revealed the following findings:

• Among 2932 patients without diabetes mellitus at baseline, 2377 were included in the as-treated population analysis.
• In the as-treated population with high-intensity statin therapy, the incidence of NODM was not significantly different between the rosuvastatin and atorvastatin groups (11.4% versus 8.8%, hazard ratio [HR] = 1.32).
• When the risk of NODM with rosuvastatin versus atorvastatin was assessed according to the achieved low-density lipoprotein cholesterol (LDL-C) level, the risk of NODM began to increase at an LDL-C level below 70 mg/dL.
• The incidence of NODM was significantly greater in the rosuvastatin group than in the atorvastatin group when the achieved LDL-C level was < 70 mg/dL (13.9% versus 8.0%; HR = 1.79).

In the post-hoc analysis of the LODESTAR trial, the incidence of new-onset diabetes mellitus was similar between rosuvastatin and atorvastatin for CAD patients undergoing high-intensity statin therapy. However, the risk of NODM appeared to be influenced by the efficacy of LDL-C reduction.

"Specifically, when LDL-C levels were below 70 mg/dL, the rosuvastatin group showed a significantly higher risk of NODM than the atorvastatin group. Conversely, when LDL-C levels were 70 mg/dL or higher, there was no significant difference in NODM risk between the two statin treatments," the researchers concluded.

Reference:

Hong, SJ., Lee, YJ., Kang, W.C. et al. 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. Cardiovasc Diabetol 23, 287 (2024). https://doi.org/10.1186/s12933-024-02386-w