Brandts Julia, Müller-Wieland Dirk
Department of Internal Medicine I, University Hospital Aachen, Pauwelsstraße, 30 52074, Aachen, Germany.
Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London, London, UK.
Curr Atheroscler Rep. 2025 Jan 8;27(1):24. doi: 10.1007/s11883-024-01270-y.
This review explores the relationship between lipid-lowering therapies, particularly statins, and the risk of new-onset diabetes (NOD). It examines the underlying mechanisms and evaluates whether other lipid-lowering agents present similar risks.
Recent meta-analyses further underscore a dose-dependent increase in NOD risk with statin therapy, particularly with high-intensity statins. In contrast to other LDL-cholesterol lowering drugs and their impact on lipid metabolism in the liver, genetic and experimental studies indicate that statins may impair insulin secretion through various mechanisms, including alterations in small G protein function, calcium signaling, and cholesterol homeostasis in pancreatic beta cells. This might contribute to the increased risk of NOD. Statins effectively reduce cardiovascular events but increase the risk of NOD, potentially via intracellular pathways affecting liver and beta-cell function. Despite the cardiovascular benefits of statins, personalized treatment strategies and alternative lipid-lowering therapies may offer safer options for patients at risk of diabetes, potentially shaping future clinical guidelines and therapeutic approaches.
本综述探讨降脂治疗，尤其是他汀类药物，与新发糖尿病（NOD）风险之间的关系。研究其潜在机制，并评估其他降脂药物是否存在类似风险。
近期的荟萃分析进一步强调，他汀类药物治疗会使NOD风险呈剂量依赖性增加，尤其是高强度他汀类药物。与其他降低低密度脂蛋白胆固醇的药物及其对肝脏脂质代谢的影响不同，基因和实验研究表明，他汀类药物可能通过多种机制损害胰岛素分泌，包括小G蛋白功能改变、钙信号传导以及胰岛β细胞中的胆固醇稳态。这可能导致NOD风险增加。他汀类药物可有效降低心血管事件，但会增加NOD风险，可能是通过影响肝脏和β细胞功能的细胞内途径。尽管他汀类药物具有心血管益处，但个性化治疗策略和替代降脂疗法可能为糖尿病风险患者提供更安全的选择，这可能会塑造未来的临床指南和治疗方法。
