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Atorvastatin, Rosuvastatin, and Simvastatin Are Associated with Excess Risk for Diabetes

Summary and Comment |
June 11, 2013

Atorvastatin, Rosuvastatin, and Simvastatin Are Associated with Excess Risk for Diabetes

  1. Paul S. Mueller, MD, MPH, FACPAU1471

Using low doses of these drugs might mitigate the risk.

  1. Paul S. Mueller, MD, MPH, FACPAU1471

Studies in people and in animal models suggest that atorvastatin, rosuvastatin (Crestor), and simvastatin are associated with elevated risk for diabetes, whereas pravastatin is associated with lower risk. In this population-based cohort study, investigators in Canada used administrative databases to assess incident diabetes between 1997 and 2010 in 471,000 older patients (age, ≥66) who were newly treated with statins (median age at treatment onset, 73).

After adjustment for multiple confounders, with pravastatin as the reference drug, risk for new diabetes was 10%, 18%, and 22% higher in participants who received simvastatin, rosuvastatin, and atorvastatin, respectively. Corresponding numbers needed to harm were 363 (simvastatin), 210 (rosuvastatin), and 172 (atorvastatin). Fluvastatin and lovastatin were not associated with excess risk. Compared with low statin doses (pravastatin, fluvastatin, and lovastatin at all doses; atorvastatin, <20 mg; rosuvastatin, <10 mg; simvastatin, <80 mg), moderate and high statin doses were associated with higher diabetes risk.

Comment

In this study, compared with pravastatin, moderate- and high-potency statins (simvastatin, rosuvastatin, and atorvastatin) were associated with higher risk for incident diabetes. Using low doses of these drugs or low-potency statins (fluvastatin and lovastatin) might mitigate this risk. Notably, these results are biologically plausible: Simvastatin diminishes insulin secretion, whereas pravastatin improves insulin sensitivity and inhibits gluconeogenesis. An editorialist recommends: “When total cardiovascular risk favours statin treatment, a low dose, low potency agent should be used to begin with.” However, some readers will disagree and will argue that, for some high-risk patients, benefits of high-potency statins outweigh the small absolute risk for incident diabetes.

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Secretary)

Citation(s):

Reader Comments (4)

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

First, do no harm! What are drugs of Choice?
CHOOSING WISELY!

Carol Vassar, MD

What was the absolute risk of DM in this population? what was their risk of heart disease without diabetes? with diabetes? What was their mortality risk with and without diabetes? What was their mortality risk with and without statins?

Competing interests: None declared

Michael G. Vesselago

It seems to me that, if the mechanism is posited to be decreasing insulin secretion, and that decrease is dose related, then stopping the statin should remove the facilitation of the diabetic state. If this logic holds then a therapeutic trial, with attention to HbA1c or blood sugar levels would be reasonable in many, if not all cases.

Diabetes is not an all or none phenomenon, as I understand it. To a substantial degree it is the result of the accumulation of contributing tendencies and factors. Certain statins have now been added to that list, along with diet , weight, level of physical activity, etc.

Does this seem reasonable, or is my reasoning flawed?

Competing interests: None declared

AYE KHINE THWIN Physician, Internal Medicine, Private hospital in Yangon

Nice and informative!

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