Commonly prescribed statin increases risk of type 2 diabetes, finds BMJ study

Two widely used statins, rosuvastatin and atorvastatin, are equally effective at preventing heart attacks, strokes and death in people with coronary artery disease. But while rosuvastatin treatment is associated with lower cholesterol levels, it also carries a higher risk of developing type 2 diabetes than atorvastatin, finds a recent study published by The BMJ.

Few trials have directly compared the long term clinical effects of the two most potent statins—rosuvastatin and atorvastatin—in people with coronary artery disease.

To address this, researchers in Korea analysed the results of the LODESTAR clinical trial, involving 4,400 adults (average age 65 years; 28% women) with coronary artery disease at 12 hospitals in South Korea. At the start of the trial, medical history and lifestyle information was recorded and participants were randomly assigned to receive either daily rosuvastatin or atorvastatin for three years from September 2016 to November 2019.

The researchers then examined differences between the two groups in terms of deaths from any cause and rates of heart attacks, strokes, and coronary revascularisation (procedures to restore blood flow to parts of the heart).

The rosuvastatin group had a higher rate of developing type 2 diabetes requiring medication (7.2% v 5.3%) and cataract surgery (2.5% v 1.5%), but other safety outcomes did not differ between the two groups.

The researchers found no discernible differences between the two groups for all cause death (2.6% in the rosuvastatin group v 2.3% in the atorvastatin group), heart attack (1.5% v 1.2%), stroke (1.1% v 0.9%) or any revascularisation (5.3% v 5.2%).

The average LDL cholesterol level during the study period was lower in the rosuvastatin group than atorvastatin group (1.8 v 1.9 mmol/L).

Reference: Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial, The BMJ, DOI 10.1136/bmj-2022-075837