The cardiovascular and mortality benefits of statins offset the risk of diabetes, according to research published in the August 11 Lancet. Statins were associated with a 28% increased risk of diabetes among patients with one or more risk factors for diabetes, but with no increased risk of diabetes for patients with no major diabetes risk factors.
Among patients with one or more risk factors for diabetes, statins reduced the risk of myocardial infarction, stroke, unstable angina, or cardiovascular death by 39%. Statins reduced the risk of these outcomes by 52% for patients with no major diabetes risk factors. For patients with one or more diabetes risk factors, statins reduced venous thromboembolism by 36% and total mortality by 17%. For patients without diabetes risk factors, statins reduced venous thromboembolism by 53% and total mortality by 22%.
Paul M. Ridker, MD, Senior Physician at Brigham and Women’s Hospital in Boston, and colleagues analyzed data from the JUPITER trial, which randomly assigned 17,603 men and women without previous cardiovascular disease or diabetes to 20 mg of rosuvastatin or placebo. Patients were followed up for as many as five years. For their analysis, the researchers categorized patients as having none or at least one of four major risk factors for diabetes (ie, metabolic syndrome, impaired fasting glucose, BMI of 30 or higher, and glycated hemoglobin A1c greater than 6%).
For participants with diabetes risk factors, use of statins prevented 134 vascular events or deaths for every 54 new cases of diabetes diagnosed. For participants without diabetes risk factors, statins prevented 86 vascular events or deaths with no new cases of diabetes diagnosed. “The cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard, including in participants at high risk of developing diabetes,” concluded Dr. Ridker.
“A major take-home message for the clinician … is that all individuals on a statin who have major risk factors for diabetes … need to be informed about the risk, monitored regularly for hyperclycemia, and advised to lose weight and take regular physical exercise to mitigate the emergence of diabetes,” said Gerald Watts, DSc, Winthrop Professor of Medicine, and Esther Ooi, PhD, a researcher, both at the University of Western Australia in Crawley, in a related editorial.
Ridker PM, Pradhan A, MacFadyen JG, et al. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380(9841):565-571.
Watts GF, Ooi EM. Balancing the cardiometabolic benefits and risks of statins. Lancet. 2012;380(9841):541-543.