Statins: Diabetes risk outweighed by CV benefit

For your doctor to determine, risks and side effects of statins compared to benefits.
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"Although it does appear that statins may increase the [chance] of diabetes in high-risk patients, this should not stop us from using these drugs, as this small risk is outweighed by the substantial reduction in cardiovascular events." That was the conclusion of Dr Barton Duell (Oregon Health & Science University, Portland), who was the discussant of five new studies on this issue reported at last week's American Heart Association 2012 Scientific Sessions.

Presenter of one of the studies, Dr David Waters (San Francisco General Hospital, CA), agreed with this view. He pointed out that the risk of diabetes vs cardiovascular benefits of statins in patients with prediabetes had been referred to as a "double-edged sword." But noting that cardiovascular events were much more serious than an increased risk of diabetes, Waters commented: "One edge of the sword is an awful lot sharper than the other."

One edge of the sword is an awful lot sharper than the other.

Summarizing the new results presented at the AHA session, Duell noted that all five studies showed increased incidence of diabetes in statin users; the absolute increase in risk is low and appears to be proportional to the pretreatment risk of diabetes and the statin dose; and diuretics, beta blockers, and antidepressants may synergistically increase the diabetes risk seen with statins.

As background, Duell reviewed two published meta-analyses:

• A review of 13 trials with a total of 91 140 participants showed a 9% increased risk for incident diabetes with statins vs placebo [1]. "This translates into one case of diabetes per 255 subjects over four years (0.4%), so an increased risk of 1% per decade. This is a very low risk," Duell said.
• A meta-analysis of five trials of high-dose vs low-dose statins, with a total of 32 753 participants, which showed a 12% increased risk for incident diabetes over a 2-5 year follow-up [2]. "This works out to two cases of diabetes per 1000 patient-years (0.2% per year, 2% over a decade). This is still very low in comparison with cardiovascular benefits."

Duell added the mechanism behind the diabetes risk is unclear. "This is likely to be multifactorial and perhaps varies from one population to another." He said it is important that people not be discouraged from using statins because of this risk. "These really are excellent drugs, but new strategies are needed to help reduce the risk of diabetes in statin users, such as increased use of bile-acid sequestrants, reduced use of niacin, and better glucose monitoring," he added.