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Statin therapy increases the risk for diabetes

Statin therapy increases the risk for diabetes
May 1926, 2 010
Statin therapy increases the risk for diabetes
Urdinola Jaime MD
Medical Association de los Andes - AK 9116 20 CS 326 - Bogotá DC Colombia-Phone 571 / 215 23 00 e-mail: jaimeurdinolamd@gmail.com- blogger: http://www.urdinolamenopausia2.blogspot.com-Symposium / Luncheon on Health Women and Menopause - Andes Medical Association - Board Room - First Floor

New data from a large meta-analysis of major statin studies suggest that these medicines to lower LDL cholesterol slightly increase the risk for Diabetes mellitus develop 1. The researchers emphasize however, that should not change clinical practice in patients with cardiovascular risk moderate or high, given the low absolute risk for developing diabetes, particularly when this fact is compared with the benefit provided by statins.

Dr. David Preiss (University of Glasgow, Scotland), one of the co-investigators of the meta-analysis has shown that although diabetes had a risk of about 9%, this is not a worrying increase as suggested by other studies . He considered a "flat." The researchers' message is that patients on statin therapy should be those that are at risk for cardiovascular (CV) moderate or high into the future. In these patients there is no doubt that the protective effects in reducing heart attack and stroke (CVA) certainly outweigh the risk of developing diabetes.

Dr. Steven Nissen (Cleveland Clinic, Ohio, USA) and who was not involved in the study considered the interpretation of the data as "responsible" and you should not alter clinical practice based on these findings, as people with diabetes previously or presented for the first time this event will have the same benefits in terms of reduction in those receiving statins, which are not resistant to insulin or who had prediabetes. Whatever this effect, this does not diminish the favorable effect of statins on clinical outcomes. No doubt today for giving statins to prediabetic diabetes because they can develop a few weeks or a few months later and denied the full benefits of these drugs.

Previous studies with statins as the WOSCOPS (West of Scotland Coronary Prevention Study), the results reported a reduction in diabetes in patients treated with pravastatin, while the recent study, large and highly publicized of the JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin), the researchers showed significantly more patients in the group taking rosuvastatin developed diabetes as a new entity after treatment an average of 1.9 years. This was the finding that attracted attention and triggered the controversy.

Meta-analysis was performed on 13 studies with more than 1 000 patients followed identical in the 2 treatment groups and for more than a year, including 91 140 participants. During follow-up of 4 years, 4 278 individuals developed diabetes, including statins 2 226 2 052 and assigned to control therapy. Statin therapy was associated with a significant increase of 9% in the risk for diabetes incidental. As noted in the overall results, this increased risk persisted when the analysis was restricted a placebo-controlled studies as the study JUPITER 2 and study in Japanese population MEGA (Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese) were excluded from the analysis.

Overall, 174 cases of diabetes among patients treated with statins resulting in an additional case of diabetes for every 255 patients taking statins for 4 years, according to researchers. Using data from the Cholesterol Trialists' Collaboration, this compares favorably with 5.4 deaths or heart attacks to be avoided for 4 years for each patient treated with statins. This benefit is even more larger when taking into account the reduction in revascularizations and stroke in patients treated with statins.

Table 1. Association between statins and the Development of Diabetes
Statins Odds ratio (95%) General
(n = 91 140) 1.09 (1.02-1.17)
atorvastatin alone (n = 7773) 1.14 (0.89-1.46)
simvastatin alone (n = 18 815) 1.11 (0.97-1.26)
Rosuvastatin alone (n = 24 714) 1.18 (1.04-1.33)
Pravastatin (n = 33 627) 1.03 (0.90-1.19)
Lovastatin (n = 6211) 0.98 (0.70- 1.38)

Researchers found no clear differences between hydrophilic statins (pravastatin and rosuvastatin) and Lipofen (atorvastatin, simvastatin and lovastatin), although there was a statistically significant increase in those treated with rosuvastatin. According to Preiss, the risk appears to be driven by a class effect and therefore no statin may be excluded. The 18% increase in risk for diabetes in the group treated with rosuvastatin included two studies on heart failure, a population per se has a higher risk for diabetes.

Richard Karas (Tufts Medical Center, Boston, USA) also points out that a similar problem exists with niacin and there are concerns for use in patients at risk for diabetes. But consider that clinicians use these two drugs in an aggressive manner, taking into account the increased risk for cardiovascular events and should not be shy to treat patients who need lipid-modifying therapies.

These findings may apply only to patients in the studies considered in the meta-analysis, those with moderate to high cardiovascular risk, and risk / benefit is less clear in low-risk patients treated with statins. But it may be responsible in any case, add the glucose control in patients treated with statins. It is also hoped an investigation of the effects of high vs. dosis bajas de estatinas en el riesgo para desarrollar diabetes.

Referencias
1- Sattar N, Preiss D, Murray HM, Welsh P, Bucley BM, de Craen AJ, Seshasai SR, McMurray JJ, Freeman DJ, Jukema JW, Macfarelane PW, Packard CJ, Stott DJ, Westendorp RG, Shepherd J, Davis BR, Pressel SL, Marchioli R, Marfisi RM, Maggioni AP, Tavazzi L, Tognoni G, Kjekshus J, Pedersen TR, Cook TJ, Gotto AM, Clearfield MB, Downs JR, Nakamura H, Ohashi Y, Mizuno K, Ray KK, Ford I. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375:735-42.
2- Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008, 359: 2195-207.

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