Statin-induced diabetes: incidence, mechanisms, and implications
Emergence of new diabetes in RCTs
A clinically relevant concern with statin therapy is a significantly increased risk of new-onset diabetes in patients on statin therapy. The JUPITER trial reported a 25% increase with rosuvastatin 20 mg, over a median follow-up of 1.9 years, compared to those on placebo 9. Since then, several meta-analyses have confirmed a smaller but significant increase with various statins ( Table 1). The analysis by Sattar et al. in 91,140 subjects showed a 9% overall risk in 13 RCTs over a mean period of 4.0 years (odds ratio [OR] 1.09; 95% CI 1.02–1.17) 10. In a subsequent meta-analysis of five intensive-dose statin trials, Preiss et al. reported a significant increase in diabetes incidence with more intensive- vs. moderate-dose statin (OR 1.12; 95% CI 1.04–1.22) in 32,752 subjects over a mean follow-up of 4.9 years 11. In general, there was no relationship between % LDL-C reduction and incident diabetes. Further analysis of baseline characteristics of the various trials reported a strong relationship between features of metabolic syndrome or pre-diabetes (age, body mass index [BMI], hypertension, fasting glucose, and triglycerides) at baseline and subsequent development of diabetes 12– 14.
Of note, the risk–benefit ratio for CVD still clearly favored statin therapy in various studies, including JUPITER, in primary prevention 13, several secondary prevention studies 12, 14, and a meta-analysis of secondary prevention studies by Preiss et al. 11. Thus, regardless of whether or not diabetes was diagnosed during statin therapy, the CVD out Continue reading