From the Guidelines
Pitavastatin has the least impact on blood glucose levels among all statins, making it the preferred choice for patients with diabetes or prediabetes. According to the 2024 recommendations on the optimal use of lipid-lowering therapy, pitavastatin uniquely does not share the propensity of other statin agents to cause a small absolute reduction of NOD, and had slight optimisation of fasting blood glucose (FBG) and HbA1c 1. This is due to its pleiotropic effects, which may be particularly beneficial in specific patient groups, such as those with metabolic disturbances, diabetes, or risk of diabetes.
Key Points
- Pitavastatin reduces LDL-C effectively, with a mean reduction of 43-47%, positioning it between high-intense and moderate-intense statins 1.
- It has a significant potential to reduce subsequent and total CVD events, with a large benefit observed in patients with elevated plasma glucose 1.
- The REPRIVE trial confirmed that pitavastatin does not have a significant impact on glucose levels, with no apparent treatment effect on glucose levels observed in 7769 participants with HIV infection 1.
- The Cholesterol Treatment Trialists’ Collaboration meta-analysis also supports the use of pitavastatin, as it was observed that statins dose-dependently increase the number of NOD, and pitavastatin may provide even greater benefit in patients with elevated plasma glucose 1.
Clinical Implications
- Pitavastatin should be recommended in monotherapy or as a part of LLT combination therapy with ezetimibe in patients with metabolic disturbances to increase the chance to be on LDL-C target, to improve adherence, and especially to reduce the risk of NOD 1.
- Starting with lower doses and monitoring blood glucose regularly is advisable when beginning any statin therapy, especially in patients with existing glucose metabolism issues.
- The use of pitavastatin may provide a better outcome in terms of morbidity, mortality, and quality of life, particularly in patients with diabetes or prediabetes, due to its minimal effects on glycemic control.
From the Research
Statin Impact on Blood Glucose Levels
- The impact of statins on blood glucose levels has been studied in several research papers 2, 3, 4, 5, 6
- Pitavastatin has been reported to have a neutral effect on serum glucose levels, unlike other statins which may increase the risk of new-onset diabetes 2, 3
- A study comparing pitavastatin and rosuvastatin found that pitavastatin had a lower diabetogenic effect in mice, with a significant difference in fasting blood glucose levels between the two groups 2
- Another study found that patients treated with pitavastatin had lower HbA1c levels compared to those treated with atorvastatin or simvastatin, suggesting a lower diabetogenic effect 4
- A pilot study found that pitavastatin decreased fasting plasma glucose and HbA1c levels in patients with type 2 diabetes mellitus, while atorvastatin and rosuvastatin had minimal effects on these parameters 5
- A retrospective study found that pitavastatin did not have an adverse influence on glycemic control in type 2 diabetic patients, unlike atorvastatin which was found to deteriorate glycemic control 6
Comparison of Statins
- Pitavastatin has been compared to other statins such as atorvastatin, rosuvastatin, and simvastatin in terms of its effect on blood glucose levels 2, 3, 4, 5, 6
- The studies suggest that pitavastatin may have a lower diabetogenic effect compared to other statins, particularly atorvastatin and simvastatin 2, 4, 5, 6
- Rosuvastatin has also been found to have a diabetogenic effect, although it may be lower than that of atorvastatin 2, 5
- Pravastatin has been found to have a neutral effect on glycemic control, similar to pitavastatin 6