Risk of diabetes with statin therapy confirmed in new meta-analysis

[kkmalaysia]

Statin therapy is associated with an increased risk of developing diabetes mellitus, report the authors of a recent meta-analysis.

In the study of 91,140 patients from 13 large, placebo-controlled trials, risk of diabetes was increased by 9 percent and was consistent across the different trials and the different types of statins used, indicating a class effect. [Lancet 2010 Feb 27;375(9716):700-1]

The authors are quick to stress, however, that the risk is low – both in terms of absolute risk and the benefits gained from the reduction in coronary events attained with statins.

For every 255 patients treated with statins over a 4 year period, just one extra case of diabetes was diagnosed, note the authors (OR 1.09; 95% CI 1.02-1.17). Yet in that same 4-year period, they estimate that 5.4 deaths or non-fatal myocardial infarctions, and nearly the same number of strokes or coronary revascularization procedures, would be avoided per 255 patients treated with statins.

This led the authors to conclude that: “In view of the overwhelming benefit of statins for reduction of cardiovascular events, the small absolute risk for development of diabetes is outweighed by cardiovascular benefit in the short and medium term in individuals for whom statin therapy is recommended. We therefore suggest that clinical practice for statin therapy does not need to change for patients with moderate or high cardiovascular risk or existing cardiovascular disease.”

They do, however, recommend that older people – who were found to be most at risk for developing diabetes as a result of statin therapy – be carefully monitored. They also advise that “the potentially raised diabetes risk should be taken into account if statin therapy is considered for patients at low cardiovascular risk or patient groups in which cardiovascular benefit has not been proven.”

Questions over the long-term side effects of statins have been growing in recent years, with some trials pointing to a possible association with diabetes and others demonstrating the opposite effect. For example, findings from the JUPITER* trial suggested an increased risk, but the data was not conclusive. Results from the WOSCOPS** study suggested that statin therapy may reduce the risk of becoming diabetic. It was the conflicting nature of the data on diabetes risk that provided the impetus for Sattar et al.’s meta-analysis. [N Engl J Med 2008;359:2195-207; Circulation 2001;103:357-62]

Writing in an accompanying comment to the article, Dr. Christopher P. Cannon of Brigham and Women’s Hospital and Harvard Medical School, Boston, US, like the authors, believes that the benefit of statin therapy greatly outweighs the risk of developing diabetes. In fact, he estimates the benefit in preventing total vascular events to the risk of diabetes to be a ratio of about 9:1 in favor of the cardiovascular benefit.

“Nonetheless,” he concludes, “this newly identified risk does warrant monitoring, and as such, in addition to periodic monitoring of liver-function tests and creatine kinase, it seems reasonable to add glucose to the list of tests to monitor in older patients who are on statins.

“Thus, whilst a new risk of statins has been identified, the risk seems small and far outweighed by the benefits of this life-saving class of drugs.”

*JUPITER: Justification for the use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin

**WOSCOPS: West of Scotland Coronary Prevention Study

by: Lynsey Alger
Source: mims.com