Meta-analyses have shown an increased risk of incident type 2 diabetes associated with statin use. However, the risk increase has been estimated to be rather small (odds ratio 1.09; 95% confidence interval (CI) 1.02–1.17) [1] and, for instance, more pronounced in the elderly and associated with intensive-dose treatment [2].
In a recent study by Culver and colleagues [3], the association between baseline statin use and incident self-reported diabetes during 3 years of follow-up was assessed in 153 840 participants in the Women’s Health Initiative trial. The data comprise follow-up from 1 004 466 person-years. Of the study partici-pants, 143 006 (~93%) were not taking statins and, in these women, incident diabetes occurred in 9166 (~6.4%) women. A total of 10 834 women (~7%) were current statin users at baseline and diabetes was reported in 1076 (~10%) women at 3 years of follow-up.
The fully adjusted hazard ratio for statin use and incident diabetes was 1.48 (95% CI 1.38–1.59). Low-potency (fluvastatin, lovastatin and pravastatin) and high-potency statins (simvastatin and atorvastatin) showed similar risk associations (hazard ratio 1.45; 95% CI 1.36–1.61 and 1.48; 95% CI 1.36–1.61, respectively). Furthermore, statin use was associated with a significantly increased risk of diabetes, especially in women with a body mass index (BMI) below 25 kg/m[+]2[/+] compared with women with BMI of 30 kg/m[+]2[/+] or higher (hazard ratios and 95% CIs were 1.89; 1.57–2.29, and 1.20; 1.09–1.33, respectively).
Importantly, the study reveals that the increased risk of diabetes with statin use was similar within different age groups as well as among women with (hazard ratio 1.46; 95% CI 1.29–1.65) and without (1,48; 95% CI 1.36–1.62) history of cardiovascular disease.
Author(s)
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Tomi Mikkola
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
Citations
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Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborate meta-analysis of randomised statin trials. Lancet 2010;375:735-42.
http://www.ncbi.nlm.nih.gov/pubmed/20167359 -
Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011;305:2556-64.
http://www.ncbi.nlm.nih.gov/pubmed/21693744 -
Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and the risk of diabetes mellitus in postmenopausal women in the Womens Health Initiative. Arch Intern Med 2012;172:144-152.
http://www.ncbi.nlm.nih.gov/pubmed/22231607 -
Baigent C, Blackwell L, Emberson J, et al; Cholesterol Treatment Trialists (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376:1670-1681.
http://www.ncbi.nlm.nih.gov/pubmed/21067804 -
Ray KK, Seshasai SR, Erqou S, et al. Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med 2010;170:102431.
http://www.ncbi.nlm.nih.gov/pubmed/20585067
