Abstract 4373725: Statin Therapy and Incident Diabetes: Identifying Susceptible Populations

Introduction: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death in the United States. Preventative treatment with cholesterol-lowering medications such as statins are key to reducing mortality and morbidity. Though these medications lower ASCVD risk, studies have demonstrated an increased risk of new onset diabetes after statin initiation. To guide patient care, risk factors for new onset diabetes after statins need to be identified. Methods: We reviewed all patients ≥ 18 years and < 75 years in our health system who were initiated on statin monotherapy. We investigated the associations between patient demographics, medical history and time to diabetes diagnosis (defined as A1C ≥ 6.5%) following commencement of statin therapy using a Cox proportional hazards model. Results: A total of 10,971 people were analyzed in our dataset. The mean age was 59 +/- 13 years, 54% were female, 84% were Caucasian, 4.1 % Black and 12.2% other races. Only 611 (5.56%) developed diabetes after statin initiation. The probability of developing statin-induced diabetes was increased by metabolic markers such as low baseline LDL (p < 0.05, Figure 1) and pre-diabetes (HR 4.7, 95% CI [3.8-5.8], p < 0.001, Figure 2). Demographics (age, sex) and traditional risk factors such as HTN or smoking did not have a statistically significant effect on time to develop diabetes. Discussion: In our analysis of over 10,000 patients, only ~6% of patients initiated on statin therapy developed new onset diabetes. Risk of developing diabetes was significantly higher for patients with pre-diabetes. Though this population is the most likely to benefit from primary prevention of ASCVD with statin therapy, they should be counseled on the risks of developing diabetes as well. Curiously, baseline high LDL level may provide a protective effect against the development of statin induced therapy. Further research is required to clarify the mechanism of this effect.