Intensive-dose statin therapy associated with increased risk of diabetes
Intensive-dose statin therapy associated with increased risk of diabetes
An analysis of data from previously published studies indicates that
intensive-dose statin therapy is associated with an increased risk of
new-onset diabetes compared with moderate-dose therapy, according to a
study in the June 22/29 issue of JAMA.
Compared with placebo, statin therapy significantly reduces
cardiovascular events among individuals with and without a history of
diabetes mellitus. Recently, findings of several trials comparing
intensive- to moderate-dose statin therapy suggested an excess risk of
new diabetes among those treated with intensive statin regimens,
according to background information in the article. According to the
authors, "Given the cardiovascular benefits of statins and the likely
increasing use of intensive statin regimens, it is important to
quantify any potential long-term risks to enable physicians and
patients to make informed choices."
David Preiss, M.R.C.P., of the University of Glasgow, United Kingdom,
and colleagues examined the associations of intensive-dose statin
therapy vs. moderate-dose therapy with the development of diabetes and
the occurrence of major cardiovascular events by conducting a
meta-analysis of published and unpublished data from relevant clinical
trials. The researchers identified 5 statin trials that met criteria
for inclusion in the analysis.
The 5 randomized clinical trials provided data on 32,752 nondiabetic
participants over a weighted average follow-up of 4.9 years. During
follow-up, 2,749 participants (8.4 percent) developed diabetes (1,449
of whom were assigned intensive-dose therapy, 1,300 assigned
moderate-dose therapy), and 6,684 (20.4 percent) experienced a major
cardiovascular event (3,134 assigned intensive-dose therapy, 3,550
assigned moderate-dose therapy). There were 149 more cases of incident
diabetes in participants assigned to intensive statin treatment than
in those receiving moderate therapy and 416 fewer patients with
cardiovascular events who received intensive-dose therapy.
An analysis of the data indicated that use of intensive-dose statin
therapy compared with moderate-dose statin therapy was associated with
a higher incidence of new-onset diabetes. However, intensive statin
therapy was associated with fewer major cardiovascular events. As
compared with moderate-dose statin therapy, the number needed to harm
per year for intensive-dose statin therapy was 498 for new-onset
diabetes while the number needed to treat per year for intensive-dose
statin therapy was 155 for cardiovascular events.
"Our findings suggest that clinicians should be vigilant for the
development of diabetes in patients receiving intensive statin
therapy," the authors write. "In conclusion, this meta-analysis
extends earlier findings of an increased incidence of diabetes with
statin therapy by providing evidence of a dose-dependent association."
(JAMA. 2011;305[24]2556-2564. Available pre-embargo to the media at
www.jamamedia.org)
Editor's Note: Please see the article for additional information,
including other authors, author contributions and affiliations,
financial disclosures, funding and support, etc.
To contact corresponding author David Preiss, M.R.C.P., email
david.preiss@glasgow.ac.uk; for Kausik K. Ray, M.D., email
Huw Beale
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