HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence from genetic analysis and randomised trials
- PMID: 25262344
- PMCID: PMC4322187
- DOI: 10.1016/S0140-6736(14)61183-1
HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence from genetic analysis and randomised trials
Abstract
Background: Statins increase the risk of new-onset type 2 diabetes mellitus. We aimed to assess whether this increase in risk is a consequence of inhibition of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), the intended drug target.
Methods: We used single nucleotide polymorphisms in the HMGCR gene, rs17238484 (for the main analysis) and rs12916 (for a subsidiary analysis) as proxies for HMGCR inhibition by statins. We examined associations of these variants with plasma lipid, glucose, and insulin concentrations; bodyweight; waist circumference; and prevalent and incident type 2 diabetes. Study-specific effect estimates per copy of each LDL-lowering allele were pooled by meta-analysis. These findings were compared with a meta-analysis of new-onset type 2 diabetes and bodyweight change data from randomised trials of statin drugs. The effects of statins in each randomised trial were assessed using meta-analysis.
Findings: Data were available for up to 223 463 individuals from 43 genetic studies. Each additional rs17238484-G allele was associated with a mean 0·06 mmol/L (95% CI 0·05-0·07) lower LDL cholesterol and higher body weight (0·30 kg, 0·18-0·43), waist circumference (0·32 cm, 0·16-0·47), plasma insulin concentration (1·62%, 0·53-2·72), and plasma glucose concentration (0·23%, 0·02-0·44). The rs12916 SNP had similar effects on LDL cholesterol, bodyweight, and waist circumference. The rs17238484-G allele seemed to be associated with higher risk of type 2 diabetes (odds ratio [OR] per allele 1·02, 95% CI 1·00-1·05); the rs12916-T allele association was consistent (1·06, 1·03-1·09). In 129 170 individuals in randomised trials, statins lowered LDL cholesterol by 0·92 mmol/L (95% CI 0·18-1·67) at 1-year of follow-up, increased bodyweight by 0·24 kg (95% CI 0·10-0·38 in all trials; 0·33 kg, 95% CI 0·24-0·42 in placebo or standard care controlled trials and -0·15 kg, 95% CI -0·39 to 0·08 in intensive-dose vs moderate-dose trials) at a mean of 4·2 years (range 1·9-6·7) of follow-up, and increased the odds of new-onset type 2 diabetes (OR 1·12, 95% CI 1·06-1·18 in all trials; 1·11, 95% CI 1·03-1·20 in placebo or standard care controlled trials and 1·12, 95% CI 1·04-1·22 in intensive-dose vs moderate dose trials).
Interpretation: The increased risk of type 2 diabetes noted with statins is at least partially explained by HMGCR inhibition.
Funding: The funding sources are cited at the end of the paper.
Copyright © 2015 Swerdlow et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.
Figures
Comment in
-
Statins and type 2 diabetes: genetic studies on target.Lancet. 2015 Jan 24;385(9965):310-2. doi: 10.1016/S0140-6736(14)61639-1. Epub 2014 Sep 24. Lancet. 2015. PMID: 25262342 No abstract available.
-
Mendelian randomisation study for statin treatment.Lancet. 2015 May 16;385(9981):1945-6. doi: 10.1016/S0140-6736(15)60957-6. Lancet. 2015. PMID: 26090639 No abstract available.
-
Mendelian randomisation study for statin treatment - Authors' reply.Lancet. 2015 May 16;385(9981):1946. doi: 10.1016/S0140-6736(15)60958-8. Lancet. 2015. PMID: 26090640 No abstract available.
Similar articles
-
Differential associations of statin treatment and polymorphism in genes coding for HMGCR and PCSK9 to risk for insomnia.Front Biosci (Landmark Ed). 2021 Dec 30;26(12):1453-1463. doi: 10.52586/5039. Front Biosci (Landmark Ed). 2021. PMID: 34994160
-
Association Between Low-Density Lipoprotein Cholesterol-Lowering Genetic Variants and Risk of Type 2 Diabetes: A Meta-analysis.JAMA. 2016 Oct 4;316(13):1383-1391. doi: 10.1001/jama.2016.14568. JAMA. 2016. PMID: 27701660 Free PMC article.
-
Association Between Genetically Proxied Inhibition of HMG-CoA Reductase and Epithelial Ovarian Cancer.JAMA. 2020 Feb 18;323(7):646-655. doi: 10.1001/jama.2020.0150. JAMA. 2020. PMID: 32068819 Free PMC article.
-
Genetic insights into statin-associated diabetes risk.Curr Opin Lipidol. 2016 Apr;27(2):125-30. doi: 10.1097/MOL.0000000000000272. Curr Opin Lipidol. 2016. PMID: 26959703 Review.
-
Statin-associated incident diabetes: a literature review.Consult Pharm. 2014;29(5):317-34. doi: 10.4140/TCP.n.2014.317. Consult Pharm. 2014. PMID: 24849689 Review.
Cited by
-
Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis.Lancet Diabetes Endocrinol. 2024 May;12(5):306-319. doi: 10.1016/S2213-8587(24)00040-8. Epub 2024 Mar 27. Lancet Diabetes Endocrinol. 2024. PMID: 38554713 Free PMC article.
-
Statins as a risk factor for diabetic retinopathy: a Mendelian randomization and cross-sectional observational study.J Transl Med. 2024 Mar 22;22(1):298. doi: 10.1186/s12967-024-05097-8. J Transl Med. 2024. PMID: 38520016 Free PMC article.
-
Potential association of genetically predicted lipid and lipid-modifying drugs with rheumatoid arthritis: A Mendelian randomization study.PLoS One. 2024 Feb 28;19(2):e0298629. doi: 10.1371/journal.pone.0298629. eCollection 2024. PLoS One. 2024. PMID: 38416767 Free PMC article.
-
Antihypertensive drug targets and breast cancer risk: a two-sample Mendelian randomization study.Eur J Epidemiol. 2024 May;39(5):535-548. doi: 10.1007/s10654-024-01103-x. Epub 2024 Feb 24. Eur J Epidemiol. 2024. PMID: 38396187 Free PMC article.
-
Hyperlipidaemia in diabetes: are there particular considerations for next-generation therapies?Diabetologia. 2024 Jun;67(6):974-984. doi: 10.1007/s00125-024-06100-z. Epub 2024 Feb 20. Diabetologia. 2024. PMID: 38376536 Free PMC article. Review.
References
-
- O'Regan C, Wu P, Arora P, Perri D, Mills EJ. Statin therapy in stroke prevention: a meta-analysis involving 121 000 patients. Am J Med. 2008;121:24–33. - PubMed
-
- Kearney PM, Blackwell L, Collins R. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117–125. - PubMed
-
- National Center for Health Statistics . Health, United States 2010: with special feature on death and dying. National Center for Health Statistics; Hyattsville, MD: 2011. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
- RG/08/008/25291/BHF_/British Heart Foundation/United Kingdom
- MC_UU_12015/1/MRC_/Medical Research Council/United Kingdom
- MR/K006584/1/MRC_/Medical Research Council/United Kingdom
- MC_UU_12013/1/MRC_/Medical Research Council/United Kingdom
- G0902037/MRC_/Medical Research Council/United Kingdom
- RG/13/2/30098/BHF_/British Heart Foundation/United Kingdom
- MC_UU_12013/5/MRC_/Medical Research Council/United Kingdom
- PG/13/66/30442/BHF_/British Heart Foundation/United Kingdom
- G0601647/MRC_/Medical Research Council/United Kingdom
- MC_UU_12013/8/MRC_/Medical Research Council/United Kingdom
- 81081/Z/06/Z/WT_/Wellcome Trust/United Kingdom
- G0600705/MRC_/Medical Research Council/United Kingdom
- 081081/Z/06/Z/WT_/Wellcome Trust/United Kingdom
- MR/K013351/1/MRC_/Medical Research Council/United Kingdom
- RG/07/008/23674/BHF_/British Heart Foundation/United Kingdom
- G8802774/MRC_/Medical Research Council/United Kingdom
- MR/K006215/1/MRC_/Medical Research Council/United Kingdom
- K013351/MRC_/Medical Research Council/United Kingdom
- 1R01 AG23522-01/AG/NIA NIH HHS/United States
- G19/35/MRC_/Medical Research Council/United Kingdom
- R01 HL036310/HL/NHLBI NIH HHS/United States
- G0100222/MRC_/Medical Research Council/United Kingdom
- MC_UP_A100_1003/MRC_/Medical Research Council/United Kingdom
- RG/08/013/25942/BHF_/British Heart Foundation/United Kingdom
- 064947/Z/01/Z/WT_/Wellcome Trust/United Kingdom
- G0701830/MRC_/Medical Research Council/United Kingdom
- R01 AG034454/AG/NIA NIH HHS/United States
- MC_UU_12019/1/MRC_/Medical Research Council/United Kingdom
- FS/07/011/BHF_/British Heart Foundation/United Kingdom
- P20 MD006899/MD/NIMHD NIH HHS/United States
- R01 AG023522/AG/NIA NIH HHS/United States
- P20MD006899/MD/NIMHD NIH HHS/United States
- HL036310/HL/NHLBI NIH HHS/United States
- RG 08/008/BHF_/British Heart Foundation/United Kingdom
- UM1 CA182913/CA/NCI NIH HHS/United States
- G1000616/MRC_/Medical Research Council/United Kingdom
- WT_/Wellcome Trust/United Kingdom
- U19 HL065797/HL/NHLBI NIH HHS/United States
- G0802432/MRC_/Medical Research Council/United Kingdom
- MC_UU_12015/5/MRC_/Medical Research Council/United Kingdom
- MC_UU_12013/3/MRC_/Medical Research Council/United Kingdom
- G0500877/MRC_/Medical Research Council/United Kingdom
- MC_U106179471/MRC_/Medical Research Council/United Kingdom
- RG/13/16/30528/BHF_/British Heart Foundation/United Kingdom
- AG034454/AG/NIA NIH HHS/United States
- PG/07/133/24260/BHF_/British Heart Foundation/United Kingdom
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical