Comparative Review of the Long-Term Effects of Atorvastatin and Rosuvastatin on Fasting Glucose and Glycated Hemoglobin in Patients with Cardiovascular Disease

Abstract

This comprehensive review evaluates the comparative long-term impact of atorvastatin and rosuvastatin on glycemic parameters—fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c)—in patients with established cardiovascular disease (CVD). A systematic examination of evidence from randomized controlled trials (RCTs), meta-analyses, and observational studies indicates a consistent class effect, whereby both high-intensity statins modestly elevate FPG and HbA1c in a dose-dependent manner. Critically, comparative data suggest a potential gradient of risk, with rosuvastatin appearing to confer a marginally greater detrimental effect on glucose metabolism than equipotent doses of atorvastatin over treatment periods extending beyond one year. This difference, while statistically significant in several head-to-head trials, is of small absolute magnitude (e.g., a between-group HbA1c difference of 0.05–0.15%). The pathophysiological mechanisms may involve differential effects on insulin sensitivity and secretion, potentially influenced by statin lipophilicity and potency. Importantly, the proven and substantial reduction in major adverse cardiovascular events with both statins decisively outweighs this modest glycemic risk. The selection between atorvastatin and rosuvastatin should, therefore, remain primarily guided by the imperative to achieve low-density lipoprotein cholesterol (LDL-C) targets, with considerations for tolerability, drug interactions, and cost. Proactive glycemic monitoring, particularly in patients with pre-diabetes or metabolic syndrome, is a recommended adjunct to optimize overall cardiometabolic management.

Received Date: February 25, 2024

Accepted Date: March 12, 2024

Published Date: April 17, 2024

Available Online at https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/550