Abstract 16055: Lipoprotein Subclasses, Size, and Statin-Associated Incident Diabetes: An Analysis From the JUPITER Trial
Statins reduce CVD events, LDL cholesterol (LDL-C) and triglycerides, with an increased risk of diabetes. The underlying predictors of statin-associated diabetes are unclear. We evaluated lipoprotein subclass and size changes in response to rosuvastatin to identify predictors of diabetes on statin therapy Among 11,918 non-diabetic participants in JUPITER (NCT00239681), lipoprotein subclasses and size were quantified by NMR spectroscopy (LipoScience, NC) prior to and 1 year after randomization to placebo or rosuvastatin (total 370 incident diabetes). Cox regression models were adjusted for diabetes risk factors Compared to baseline, rosuvastatin lowered LDL-C and particles by lowering cholesterol-enriched large LDL (58%) and IDL (46%), with less relative lowering of cholesterol-poor small LDL (22%), resulting in smaller LDL size (1.5%). Rosuvastatin lowered (15%-20%) triglycerides, VLDL triglycerides, and VLDL particles by lowering large (15%), medium (7%), and small (27%) particles, and increasing VLDL size (3%) (all p<0.0001). Among statin-allocated individuals, after adjusting for typical risk factors, incident diabetes was inversely associated with baseline levels of LDL-C, HDL-C, large LDL particles, and LDL size, and positively associated with baseline triglycerides, non-HDL-C, ApoB, LDL particles, VLDL particles, VLDL triglycerides and size (Table). Similar associations were seen in on-treatment rosuvastatin and placebo groups In JUPITER, random allocation to rosuvastatin altered the lipoprotein subclass profile in a manner associated with the development of diabetes Adjusted Hazard Ratios (95% CI) and Risk of Incident Diabetes with Rosuvastatin Baseline parameters HR per 1-SD p value LDL-C .86 (0.76-0.98) .02 HDL-C .69 (0.54-0.87) .002 Triglycerides 1.62 (1.41-1.86) <.0001 Non-HDL-C 1.20 (1.04-1.39) .01 ApoB 1.35 (1.18-1.55) <.0001 Total LDL* 1.32 (1.15-1.51) <.0001 Large LDL* .79 (0.71-0.87) <.0001 Small LDL* 1.71 (1.40-2.08) <.0001 IDL* .97 (0.85-1.11) .69 LDL size .66 (0.58-0.75) <.0001 Total VLDL* 1.16 (1.00-1.34) .046 Large VLDL* 1.78 (1.51-2.10) <.0001 Medium VLDL* 1.35 (1.15-1.58) .0002 Small VLDL* .93 (0.82-1.06) .30 VLDL size 1.58 (1.39-1.80) <.0001 VLDL triglycerides 1.51 (1.31-1.73) <.0001 *particles