Statins are associated with a small diabetes risk, but benefits outweigh concerns

In a recent study published in Lancet Diabetes and Endocrinology, a large collaborative team of researchers investigated the increased risk of diabetes with statin use, including which types of individuals or populations are at higher risk of diabetes with statin treatment and at what point after starting statin treatment the risk of diabetes increases. We investigated the associated factors. increased risk and whether statin use affects glycemic control in patients with known diabetes.

study: Effect of statin therapy on diagnosis of new-onset diabetes and glycemic exacerbations in large randomized, blinded statin trials: a meta-analysis of individual participant data.s. Image credit: Fahroni / Shutterstock

background

One of the leading causes of death worldwide is cardiovascular disease, and low-density lipoprotein (LDL) cholesterol is a major risk factor for atherosclerotic cardiovascular disease.of Risk of atherosclerosis It also increases significantly in diabetics. Treatment with statins, such as 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, reduces the incidence of ischemic stroke and myocardial infarction by one-fourth when suppressing 1 mmol/L LDL cholesterol reduction. It is thought that.

However, results from a recent meta-analysis showed that standard statin therapy is associated with a 10% increased risk of new-onset diabetes compared to usual treatment for hypercholesterolemia and a placebo. I am. The risk of developing new diabetes was also found to be higher with more intensive statin therapy regimens. However, aspects of the association between statin use and diabetes risk remain unclear, such as the impact of statin use on higher-risk populations and those already diagnosed with diabetes.

About research

In this study, researchers obtained information about diabetes, adverse events related to diabetes treatment, and records of blood glucose measurements from participants enrolled in the Cholesterol Treatment Trial List collaboration. This collaboration consists of double-blind, long-term randomized controlled trials evaluating cholesterol treatments. Statin therapy.

The study included statin therapy trials with at least 1,000 participants and an average follow-up of 2 years. Furthermore, the only difference mandated by the protocols of these trials had to be in the administration of statin therapy or placebo, or the intensity of statin therapy. Individual participant data, which also included information on comorbidities, anthropometric measurements, and blood glucose test results, were used in the meta-analysis.

Diabetes-related adverse events considered in the analysis included a diagnosis of diabetes, diabetes-related complications such as glucose control or ketosis, or other complications specific to diabetes. Drugs that lower blood glucose levels were identified from prescribing information using a standard drug dictionary, and fasting status was used to categorize blood glucose concentrations.

History of diabetes, occurrence of diabetes-related adverse events, fasting blood glucose level ≥7 mmol/L, or use of blood glucose lowering medications before participant enrollment or assignment into the study defined baseline diabetes. To do. In patients without baseline diabetes, the occurrence of diabetes-related adverse events, blood glucose levels exceeding the standard cutoff, or use of blood glucose-lowering drugs since the start of the study was considered new. Diagnosis of the onset of diabetes.

result

This study found that statin use was indeed associated with an increase in new-onset diabetes, but the association was modest and dose-dependent. Furthermore, although a small increase in blood glucose was observed after statin treatment, most of the diagnoses of new-onset diabetes were in people whose baseline blood glucose markers were already quite close to the threshold for diabetes diagnosis.

The potential increase in cardiovascular disease risk that can result from small increases in blood glucose levels is explained by the large reduction in cardiovascular disease risk produced by lowering LDL cholesterol with statin therapy. Furthermore, the effect of statin therapy on glycemic control in diabetic patients was similar to that observed in new-onset diabetes.

The results also showed that the rate of new diabetes was significantly higher in trials that included high-intensity statin regimens compared to trials that evaluated moderate-intensity or low-intensity statin regimens in both intervention and placebo groups. suggested that. The researchers believe that this significant difference in event rates may be due to more frequent follow-up, including more frequent blood glucose testing, in trials evaluating high-intensity regimens.

conclusion

Overall, the results of this study suggest that although statin therapy is associated with an increased incidence of new-onset diabetes, the association is modest and dose-dependent. Additionally, people whose blood sugar markers were already very close to the threshold for diabetes diagnosis were at higher risk of developing new diabetes. The potential increase in cardiovascular disease risk due to the hyperglycemic effects of statins was mitigated by the overall reduction in cardiovascular disease risk with statin therapy.