Statins and Diabetes Risk: An Elaboration

The next issue of The Medical Letter (1450; September 1, 2014) will include a short article, prompted by an FDA warning, on the risk of developing diabetes from taking a statin. We cite briefly (one sentence) an interesting article that deserves more attention (PM Ridker et al. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet 2012; 380:565). This was a post-hoc analysis of an earlier randomized controlled trial of rosuvastatin 20 mg versus placebo, which found that an increased risk of diabetes with the drug was demonstrable among patients who had one or more major risk factors for diabetes, but not among those who did not.

The JUPITER study was limited to healthy men and women with LDL cholesterol <130 mg/dL and high-sensitivity C-reactive protein >2 mg/L. Patients with a history of diabetes were excluded, but more than half of these healthy people with normal serum cholesterol levels (11,508 of 17,603) had one or more major risk factors for the disease (metabolic syndrome, impaired fasting glucose, body-mass index >30 kg/m2, or HbA1c >6%). The primary endpoint of the original study was a cardiovascular event. In patients with major diabetes risk factors, taking rosuvastatin reduced the incidence of the primary endpoint by 39% and increased the incidence of diabetes by 28%. In those without diabetes risk factors, the drug reduced the primary endpoint by 52% and did not increase the incidence of diabetes compared to the incidence in patients randomized to placebo.

The authors point out in their discussion that patients with major risk factors for diabetes are, of course, likely to develop the disease, and when they do, treatment with a statin is generally indicated. Presumably a patient population that was not selected for having a normal serum cholesterol level would have an even higher risk of developing diabetes than that in the JUPITER trial. The message seems clear.

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