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High-Potency Statins Are Associated with Excess Risk for Diabetes

June 17, 2014

High-Potency Statins Are Associated with Excess Risk for Diabetes

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

But the number need to treat for 2 years was 342 in a cohort of patients with cardiovascular disease.

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

Meta-analyses of randomized trials have shown that statin use is associated with excess risk for developing diabetes. These findings prompted the FDA to require label changes for statins to address this concern. In this study, investigators used data from eight population-based Canadian, U.S., and U.K. cohort studies to evaluate risk for developing diabetes in 137,000 patients (age, ≥40) who were hospitalized for major adverse cardiovascular events and who received new prescriptions for high-potency or low-potency statins.

Diabetes incidence in new users of high-potency statins (rosuvastatin [Crestor] ≥10 mg, atorvastatin ≥20 mg, or simvastatin ≥40 mg) was compared with incidence in new users of low-potency statins (all other statins). Within the first 2 years of statin use, new-onset diabetes was significantly more common with high-potency statins than with low-potency statins (rate ratio, 1.2). Risk was highest during the first 4 months of use (RR, 1.3).

Comment

In this study, which involved patients with established cardiovascular disease, high-potency statins were associated with excess risk for diabetes compared with low-potency statins. However, the absolute risk was small: The authors estimate that 342 secondary-prevention patients would need to be treated with a high-potency statin instead of a low-potency statin for 2 years to cause 1 additional case of diabetes. Nonetheless, clinicians should consider this risk when prescribing high-potency statins. Notably, the mechanisms by which statins might cause diabetes are unknown.

  • 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 (Vice President)

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Reader Comments (4)

mary oladokun Other, Unspecified

does that means diabetes patient should not take statin?

Ian Naicker, MPH Other Healthcare Professional, Pharmacology/Pharmacy, Novartis

Is it not possible that patients who warranted high dose statins had a higher risk of developing diabetes at baseline? The fact that prescribers chose high dose statins for these patients is an indication that these two groups of patients are not homogenous, one group may have an inherent higher risk of developing diabetes.

BRIAN WICKWIRE Physician, Internal Medicine, Community Health Center

What would the estimated number required to treat, to cause one case of diabetes in patients with impaired fasting glucose?

JAVIER CERERO Physician, Pediatrics/Adolescent Medicine, Private Practice

is it reversible if statin is withdrawn ?

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