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

Hong, SJ; Lee, YJ; Kang, WC; Hong, BK; Lee, JY; Lee, JB; Yang, TH; Yoon, J; Lee, SJ; Ahn, CM; Kim, JS; Kim, BK; Ko, YG; Choi, D; Jang, Y; Hong, MK; LODESTAR investigators

doi:10.1186/s12933-024-02386-w

Type 2 & other diabetes

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 DiabetolPublished 7 Aug 2024Post-hoc analysis of the LODESTAR randomised trial

Primary result · NODM, high-intensity statin as-treated populationResultHazard ratio 1.32 95% CI 0.98–1.77

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Authors' conclusion

Among CAD patients receiving high-intensity statin therapy, the incidence of NODM was not significantly different between rosuvastatin and atorvastatin. However, a drug effect of the statin type on NODM was observed when the achieved LDL-C level was < 70 mg/dL.

Study context

Population: Patients with coronary artery disease (CAD) without DM at baseline, treated with high-intensity statin therapy2,377 in as-treated analysis
Participants: 2,932 patients

Comparison: Rosuvastatin vs atorvastatin
Rosuvastatinn = 948
Atorvastatinn = 856reference
Primary endpoint: Incidence of new-onset DM (NODM)
Follow-up: 3 years

Methodological details2-by-2 factorial randomization, as-treated population

2-by-2 factorial randomization
As-treated population

Primary result

As reported in the abstract

NODM, high-intensity statin as-treated population

Hazard ratio

1.32

95% CI 0.98–1.77

P = 0.071

Events by treatment group

Rosuvastatin11.4%106

Atorvastatin8.8%73

Rosuvastatinvs Atorvastatin

HR 1.32 (95% CI 0.98–1.77); P = 0.071

Further findings

Outcome	Rosuvastatin	Atorvastatin	← Lower with rosuvastatin ←→ Higher with rosuvastatin →	HR (95% CI)	P value
NODM, achieved LDL-C <70 mg/dL subgroup	13.9%	8.0%	0.20.5125	1.79 (1.18–2.73)	P = 0.007
			0.20.5125Hazard ratio (log scale)

New-onset diabetes mellitus (NODM) by achieved low-density lipoprotein cholesterol (LDL-C): risk began to increase at LDL-C <70 mg/dL

Risk of NODM with rosuvastatin vs atorvastatin began to increase at LDL-C below 70 mg/dL

Original publication

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. Published 7 August 2024. doi:10.1186/s12933-024-02386-w

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