1. Kuznar, Wayne
  2. Kayyali, Andrea MSN, RN


According to this study:


* Both high- and moderate-dose statins increase the risk of new-onset diabetes, although the relationship appears to be dose dependent.


* The totality of outcomes still favors high-dose statin use for the secondary prevention of cardiovascular events.



Article Content

Research has suggested that statin therapy, used to lower cholesterol levels and, consequently, the risk of cardiovascular events, increases patients' risk of developing diabetes. According to a recent meta-analysis, evidence is growing that the risk is also dose dependent. Five randomized controlled trials of statins in which intensive-dose therapy (80 mg of either simvastatin or atorvastatin) was compared with moderate-dose therapy, using cardiovascular outcomes as the end point, in 32,752 nondiabetic patients with a history of coronary heart disease served as the basis for this analysis. Data on incident (new-onset) diabetes were obtained from the trials' investigators.


Over a mean follow-up of 4.9 years, 1,449 trial participants who were assigned to intensive-dose therapy and 1,300 who were assigned to moderate-dose therapy developed diabetes. The larger number of cases of incident diabetes in the intensive-dose group corresponded to a 12% increased relative risk, or an excess of two cases of diabetes per 1,000 patient-years. The odds of developing diabetes were similar in patients taking either intensive-dose statin regimen.


Patients assigned to intensive-dose statins suffered 416 fewer cardiovascular events, corresponding to a relative reduction of 16% over moderate-dose therapy, or 6.5 fewer first major cardiovascular events per 1,000 patient-years. However, only atorvastatin 80 mg was associated with a significant cardiovascular benefit, in comparison with moderate-dose statin therapy; the 5% relative reduction in cardiovascular risk observed with simvastatin 80 mg failed to achieve statistical significance.


The authors point out that despite the apparently dose-dependent increase in diabetes risk with statin therapy, the net cardiovascular benefit seen in these trials still favors intensive-dose statin therapy in high-risk patients.-WK




Preiss D, et al. JAMA 2011;305(24):2556-64.