Elizabeth Barrett-Connor, MD
Does intensive-dose statin therapy increase risk for incident diabetes mellitus (DM)?
Included studies compared intensive-dose with moderate-dose statin therapy and had ≥ 1000 patients followed for ≥ 1 year and an identical mean follow-up between groups. Only patients without DM at baseline were included in the analyses. Outcomes included incident DM (adverse event report of newly diagnosed DM, commencement of glucose-lowering medication, or 2 fasting plasma glucose values ≥ 7.0 mmol/L [126 mg/dL]) and a composite of cardiovascular (CV) events (CV death, nonfatal myocardial infarction, nonfatal stroke, coronary artery bypass surgery, and percutaneous coronary intervention).
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (1996 to Mar 2011) were searched for randomized controlled trials (RCTs) published in English. 5 RCTs (n = 32 752 patients without DM, mean age 62 y) with a weighted mean follow-up of 4.9 y met the selection criteria; all were secondary prevention trials. Mean high-density lipoprotein cholesterol (HDL-C) level ranged from 1.0 to 1.2 mmol/L (39 to 47 mg/dL), and mean low-density lipoprotein level ranged from 2.5 to 3.2 mmol/L (98 to 125 mg/dL). Trials were of high-quality, with a median Delphi quality score of 9 out of 9.
Meta-analysis showed that intensive-dose statins increased risk for incident DM compared with moderate-dose statins (Table). This treatment effect was modified by baseline triglyceride level (P = 0.04 for interaction) (Table) but not baseline age, body mass index, fasting glucose, or HDL-C level. Fewer patients in the intensive-dose group than in the moderate-dose group had the composite CV outcome (Table).
Intensive-dose statin therapy increases risk for incident diabetes mellitus but reduces cardiovascular events compared with moderate-dose therapy.
*CV = cardiovascular; other abbreviations defined in Glossary. RRI, RRR, NNH, NNT, and CI calculated from odds ratios and control event rates in article.
†P = 0.04 for treatment–triglyceride level interaction.
‡CV death, nonfatal myocardial infarction, nonfatal stroke, coronary artery bypass surgery, and percutaneous coronary intervention.
§Significant heterogeneity (I2 = 74%, P = 0.004).
Barrett-Connor E. Review: Intensive-dose statin therapy increases incident diabetes compared with moderate-dose therapy. Ann Intern Med. ;155:JC4–7. doi: 10.7326/0003-4819-155-8-201110180-02007
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Published: Ann Intern Med. 2011;155(8):JC4-7.
Cardiology, Coronary Risk Factors, Diabetes, Dyslipidemia, Endocrine and Metabolism.
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