Case report: dyslipidaemia-dramatic increase in haemoglobin A1c following statin initiation

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Statin therapy is linked to an increased risk of hyperglycemia and new-onset diabetes mellitus.
• The absolute increase in glycosylated hemoglobin (HbA1c) is usually small, with significant rises being rare.

Observation:

• A 52-year-old man with hyperlipidemia was initiated on high-intensity rosuvastatin for primary prevention.
• He developed symptoms of hyperglycemia (polyuria, weight loss) and an elevated HbA1c of 12.4% shortly after starting rosuvastatin.
• Discontinuation of rosuvastatin led to symptom resolution and normalization of HbA1c.

Findings:

• The patient experienced recurrent hyperglycemia and polyuria upon re-initiation of rosuvastatin for secondary prevention after an acute coronary syndrome.
• Switching to atorvastatin resulted in symptom resolution and normalization of HbA1c, suggesting rosuvastatin as the likely cause of hyperglycemia.
• This case demonstrates a rare instance of clinically significant, reversible hyperglycemia attributed to high-intensity statin therapy.

Implications:

• Clinicians should consider the potential for statin-induced hyperglycemia, especially with high-intensity statins.
• Careful monitoring of glycemic control is warranted in patients initiating or re-initiating statin therapy.
• This case highlights the importance of considering drug-induced causes for new-onset hyperglycemia.