ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Atherosclerosis and Vascular Medicine
Risk of New-Onset Diabetes Across Individual Statins in Secondary Prevention: Results from the Korean National Health Insurance Service Cohort
Eun Jin Park 1
Yoonjee Park 2
Dong Oh Kang 1
Soohyung Park 1
Seung-Young Roh 1
Jin Oh Na 1
Jin Won Kim 1
Eung Ju Kim 1
Seung-Woon Rha 1
Chang Gyu Park 1
Cheol Ung Choi 1
1. Guro Hospital, Cardiovascular Center, Korea University, Seoul, Republic of Korea
2. Department of Cardiology, Bucheon Sejong Hospital, Bucheon-si, Republic of Korea
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Abstract
Statins are the cornerstone of secondary prevention in atherosclerotic cardiovascular disease (ASCVD), but their association with new-onset diabetes mellitus (NODM) remains incompletely defined. Whether the risk of NODM differs among individual statins within the same intensity class has not been well established. Using the Korean National Health Insurance Service (NHIS) database, we identified 29,826 patients with established ASCVD who initiated statin therapy between 2009 and 2012 and were followed for up to five years. The primary endpoint was incident NODM, defined by new diagnostic coding plus antidiabetic medication use after a three-year window period. The secondary endpoint was major adverse cardiac and cerebrovascular events (MACCE). Overall, 11,918 patients (40.0%) developed NODM. The incidence of NODM was comparable between high-and moderate-intensity statins (absolute risk 42.9% vs. 41.1%). In the moderate-intensity group, rosuvastatin (absolute risk 41.3%, adjusted HR 1.07, 95% CI 1.01–1.14; p=0.03), pravastatin (absolute risk 43.4%, HR 1.19, 95% CI 1.02–1.38; p=0.03), and simvastatin (absolute risk 43.8%, HR 1.15, 95% CI 1.06–1.20; p<0.001) were associated with higher NODM risk than atorvastatin (absolute risk 40.3%, reference), while no significant differences were observed for fluvastatin or pitavastatin. MACCE incidence was similar across statins. In this nationwide cohort of secondary prevention patients, the risk of NODM differed across individual statins despite similar cardiovascular outcomes. These findings suggest that the diabetogenic effect of statins is agent-specific rather than a uniform class effect, underscoring the importance of individualized statin selection balancing metabolic and cardiovascular benefits.
Summary
Keywords
atherosclerotic cardio-cerebral vascular diseases (ASCVD), National health insurane service, New onset diabetes mellitus, Secondary Prevention, statin, Statin intensity
Received
10 October 2025
Accepted
17 February 2026
Copyright
© 2026 Park, Park, Kang, Park, Roh, Na, Kim, Kim, Rha, Park and Choi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Cheol Ung Choi
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