Role of Gut Microbiota in Statin-Associated New-Onset Diabetes—a Cross-Sectional and Prospective Analysis of the FINRISK 2002 Cohort

Abstract

<h3>Background:</h3><p>Dyslipidemia is treated effectively with statins, but treatment has the potential to induce new-onset type-2 diabetes. Gut microbiota may contribute to this outcome variability. We assessed the associations of gut microbiota diversity and composition with statins. Bacterial associations with statin-associated new-onset type-2 diabetes (T2D) risk were also prospectively evaluated.</p><h3>Methods:</h3><p>We examined shallow-shotgun-sequenced fecal samples from 5755 individuals in the FINRISK-2002 population cohort with a 17+-year-long register-based follow-up. Alpha-diversity was quantified using Shannon index and beta-diversity with Aitchison distance. Species-specific differential abundances were analyzed using general multivariate regression. Prospective associations were assessed with Cox regression. Applicable results were validated using gradient boosting.</p><h3>Results:</h3><p>Statin use associated with differing taxonomic composition (R², 0.02%; q=0.02) and 13 differentially abundant species in fully adjusted models (MaAsLin; q<0.05). The strongest positive association was with <em>Clostridium sartagoforme</em> (β=0.37; SE=0.13; q=0.02) and the strongest negative association with <em>Bacteroides cellulosilyticus</em> (β=−0.31; SE=0.11; q=0.02). Twenty-five microbial features had significant associations with incident T2D in statin users, of which only <em>Bacteroides vulgatus</em> (HR, 1.286 [1.136–1.457]; q=0.03) was consistent regardless of model adjustment. Finally, higher statin-associated T2D risk was seen with <em>[Ruminococcus] torques</em> (ΔHR_statins, +0.11; q=0.03), <em>Blautia obeum</em> (ΔHR_statins, +0.06; q=0.01), <em>Blautia</em> sp<em>. KLE 1732</em> (ΔHR_statins, +0.05; q=0.01), and beta-diversity principal component 1 (ΔHR_statin, +0.07; q=0.03) but only when adjusting for demographic covariates.</p><h3>Conclusions:</h3><p>Statin users have compositionally differing microbiotas from nonusers. The human gut microbiota is associated with incident T2D risk in statin users and possibly has additive effects on statin-associated new-onset T2D risk.</p>