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Higher-Dose Statins Linked to Moderate Increase in Diabetes Risk — Physician’s First Watch

Medical News |
June 2, 2014

Higher-Dose Statins Linked to Moderate Increase in Diabetes Risk

By Kelly Young

Edited by Susan Sadoughi, MD , and Jaye Elizabeth Hefner, MD

Higher doses of statins are associated with greater risk for incident diabetes than lower doses, according to a BMJ study.

Using healthcare databases from Canada, the UK, and the US, researchers identified 137,000 patients who were prescribed statins after hospitalization for a major cardiovascular event. At 2 years, patients prescribed a higher-dose statin (rosuvastatin, 10 mg and up; atorvastatin, 20 mg and up; simvastatin, 40 mg and up) had a 15% higher rate of new diabetes diagnoses than lower-dose statin users. Incidence rates were highest in the first 4 months.

The authors conclude: "Clinicians should consider our study results when choosing between lower potency and higher potency statins in secondary prevention patients, perhaps bearing in mind that head-to-head randomized trials of higher potency versus lower potency statins have not shown a reduction in all-cause mortality or serious adverse events in secondary prevention patients with stable disease."

Reader Comments (9)

Tom Simpson, PharmD Other Healthcare Professional, Pharmacology/Pharmacy, Pharmacy Donsultant Services

The 3 statins chosen for the study are probably 3 3 most like to contribute to diabetes.
Yes there probably is a dose relationship, but why do these studies keep leaving out pravaststin, the one probably least likely to contribute to diabetes?

Dr. V Kantariya MD Physician, Family Medicine/General Practice

How much is Too Much? Statins are not the same, they are different. Pravastatin, fluvastatin, and lovastatin at all doses were not associated with Excess Risk for Diabetes (BMJ 2013 May 23). Are these Statins Drugs of Choice in Prediabetic High Coronary Risk Patients?

Sheila Doyle Physician, Family Medicine/General Practice, 1366 Yonge Street

I agree and perhaps medication should not be te first step

Sheila Doyle Physician, Family Medicine/General Practice, office

I agree and perhaps medication should not be te first step

Irv Loh MD Physician, Cardiology, Ventura Heart Institute (www.venturaheart.com); Thousand Oaks, CA

Two things: patients (prior to current less precise guidelines) have statin doses predicated on LDL-C levels and risk status, so higher doses and more potent statins prescribed in those patients; meticulous multi-variate analyses may need to search those higher risk (and higher dose statin) patients for pre-diabetic tendencies that become evident with time, spuriously increasing the ostensible association between statin dose and subsequent presentation of overt diabetes.
Second, in the risk-benefit calculus of avoiding statins because of the "risk of developing diabetes" (I've had high CVD patients who have asked if they should stop statins because of the publicized risk in the lay media), we need to tell patients that IF they develop diabetes, we need to START statins for secondary prevention.

JOHN J. WILLIAMS, MD,JD Physician, Urology, NYC

CONTRAST THE TRIALS OF HIGH DOSE LIPITOR. RESULTS OF THE HIGH DOSE TRIAL SHOWED 80mg REVERSED MUCH OF THE ATHEROSCLEROSIS; 40mg PREVENTED FURTHER DEPOSITION OF PLAQUE.

Gayle A. Roberts, MD Physician, Oncology, Tuscaloosa, Alabama

Does no one mention diet and exercise anymore as a control for hyperlipidemia and AODM? Why must we always reach for the prescription pad, before even considering physical means of control? Being a physician means we should consider the safety and well being of our patients. Because of the recent cardiovascular event it would be prudent to use a statin, but, of course, we should be certain of the laboratory analysis before even deciding on the use of medications. If time is not taken to fully evaluate the patient, perhaps we should consider whether a consultation with a "real physician" is indicated or notl.

Harry Haber Other Healthcare Professional, Health Law/Ethics/Public Policy, Medical writer work at home Rose Bay Aust

Review articles needed to explain different opinions on statins , I am more confused that ever as regards safety and benefits.

Morris L . Orocofsky M.D. Physician, Neurology, Community Clinic

Is it because the low intensity users have been sold on the 50% risk reduction of exercise.?

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