Pravastatin and the development of diabetes mellitus - Evidence for a protective treatment effect in the West of Scotland Coronary Prevention Study

Background-We examined the development of new diabetes mellitus in men aged 45 to 64 years during the West of Scotland Coronary Prevention Study. Methods and Results-Our definition of diabetes mellitus was based on the American Diabetic Association threshold of a blood glucose level of greater than or equal to7.0 mmol/L. Subjects who self-reported diabetes at baseline or had a baseline glucose level of greater than or equal to7.0 mmol/L were excluded from the analyses. A total of 5974 of the 6595 randomized subjects were included in the analysis, and 139 subjects became diabetic during the study. The baseline predictors of the transition from normal glucose control to diabetes were studied. In the univariate model, body mass index, log triglyceride, log white blood cell count, systolic blood pressure, total and HDL cholesterol, glucose, and randomized treatment assignment to pravastatin were significant predictors. In a multivariate model, body mass index, log triglyceride, glucose, and pravastatin therapy were retained as predictors of diabetes in this cohort. Conclusions-We concluded that the assignment to pravastatin therapy resulted in a 30% reduction (P = 0.042) in the hazard of becoming diabetic. By lowering plasma triglyceride levels, pravastatin therapy may favorably influence the development of diabetes, but other explanations, such as the anti-inflammatory properties of this drug in combination with its endothelial effects, cannot be excluded with these analyses.