Comparison of Pitavastatin Plus Ezetimibe Versus High-Intensity Statin Therapy on Risk of New-Onset Diabetes Mellitus

Inclusion Criteria: * Age Requirement: * Patients aged 18 years or older. Glycemic Status: * Patients who are not taking oral hypoglycemic agents (OHAs) and meet all of the following criteria: * Fasting glucose less than 126 mg/dL.\* * HbA1c less than 6.5%. * Plasma glucose less than 200 mg/dL after 2 hours during a 75 g oral glucose tolerance test (OGTT).\*Note: For fasting glucose, two measurements of 126 mg/dL or greater within 3 months are required for a diagnosis of diabetes. Cardiovascular Disease: * Patients with established atherosclerotic cardiovascular disease, defined as having at least one of the following: * Coronary Heart Disease (CHD): * Documented history of myocardial infarction (MI). * History of coronary revascularization. * 50% stenosis of a major epicardial coronary artery confirmed by cardiac catheterization, computed tomography (CT), or coronary angiography. * Cerebrovascular Disease: \>History of stroke of atherosclerotic origin. * History of carotid revascularization. \>≥50% stenosis of the carotid artery confirmed by X-ray angiography, magnetic resonance (MR) angiography, CT angiography, or Doppler ultrasound. * Symptomatic Peripheral Arterial Disease (PAD): \>Intermittent claudication with an ankle-brachial index (ABI) of 0.90 at rest. * Intermittent claudication with ≥50% stenosis of a peripheral artery (excluding the carotid artery) confirmed by X-ray angiography, MR angiography, CT angiography, or Doppler ultrasound. * History of revascularization of peripheral arteries (excluding carotid arteries). * Lower extremity amputation at or above the ankle due to atherosclerotic disease (excluding trauma or osteomyelitis). Dietary Requirements: * Patients must be on a stable diet prior to randomization and able to adhere to the National Cholesterol Education Program (NCEP) Therapeutic Lifestyle Change (TLC) diet or an equivalent throughout the study. Informed Consent: * Subjects or their legal representatives must provide written informed consent to the study protocol and clinical follow-up schedule. * An informed consent form approved by the institutional review board (IRB)/ethics committee of the study site must be signed. Exclusion Criteria: * Patient is pregnant or breastfeeding or of childbearing potential. * Requires concomitant administration of strong inhibitors of CYP3A4 (itraconazole, ketoconazole, protease inhibitors, erythromycin, clarithromycin, telithromycin, and nefazodone) or CYP2C9 (relative contraindication not dependent on CYP450 statins). * Chronic kidney disease (eGFR \< 30 ml/min/1.73m²) or dialysis-dependent renal failure. * Uncontrolled hypothyroidism. * Personal or family history of an inherited muscle disorder. * History of statin-induced muscle toxicity. * Alcohol-dependent person. * Hypersensitivity to statins and ezetimibe. * Hemodynamic instability at the time of enrollment: cardiogenic shock, refractory ventricular arrhythmia, or congestive heart failure (New York Heart Association class IV) at randomization. * History of hemorrhagic stroke or intracranial hemorrhage, TIA, or ischemic stroke within the past 6 months. * Planned surgery requiring discontinuation of statins or ezetimibe within 6 months of randomization. * Current treatment for active cancer. * Clinically significant abnormal findings identified at the screening visit, physical examination, laboratory tests, or electrocardiogram that, in the investigator's judgment, may interfere with safe completion of the study. * Liver disease or biliary obstruction, elevated liver enzymes (ALT or AST \> the upper limit of normal) or elevated total bilirubin (total bilirubin \> 2 times the upper limit of normal) at screening. * Life expectancy for noncardiac or cardiac causes \< 1 year. * Unwillingness or inability to comply with the procedures described in this protocol. * Previously diagnosed with diabetes mellitus and compliant with lifestyle modification and taking oral hypoglycemic agents (OHAs) or insulin.