- •
Statin use is associated with a modest increase in risk for new-onset type 2 diabetes mellitus compared with placebo or usual care.
- •
The risk for diabetes seems to be greater for intensive-dosage statin therapy, and to be most evident in those with major risk factors for diabetes.
- •
The cardiovascular benefits of statin therapy outweigh the potential risk for diabetes development, with several cardiovascular events generally prevented for each excess case of diabetes.
- •
No changes to clinical practice
Statins and Diabetes
Section snippets
Key points
West of Scotland Coronary Prevention Study
The West of Scotland Coronary Prevention Study (WOSCOPS) was one of the first clinical trials to draw attention to a possible association, albeit inverse in that trial, between T2DM risk and statin use.14 An examination of the incidence of new-onset diabetes mellitus among 5974 subjects receiving pravastatin in WOSCOPS indicated that pravastatin therapy was associated with a lesser risk for development of diabetes mellitus, defined as a blood glucose level of 7.0 mmol/L or greater (126 mg/dL).14
Summary
- •
Statin use is associated with a modest increase in risk (∼10%–12%) for new-onset T2DM, compared with placebo or usual care.
- •
Intensive dosage statin therapy seems to increase diabetes risk beyond that of moderate dosage statin therapy.
- •
Excess risk for diabetes with statin use is most clearly evident in those with major risk factors for diabetes.
- •
The cardiovascular benefits of statin therapy outweigh the potential risk for diabetes development, with several cardiovascular events prevented for each
References (44)
- et al.
Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial
Lancet
(2012) - et al.
Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statin trials
Lancet
(2010) - et al.
Predictors of new-onset diabetes in patients treated with atorvastatin: results from 3 large randomized clinical trials
J Am Coll Cardiol
(2011) - et al.
An assessment by the statin diabetes safety task force: 2014 update
J Clin Lipidol
(2014) - et al.
HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence from genetic analysis and randomised trials
Lancet
(2015) - et al.
2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
J Am Coll Cardiol
(2014) - et al.
Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial)
Am J Cardiol
(2003) - et al.
Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12,064 survivors of myocardial infarction: a double-blind randomised trial
Lancet
(2010) - et al.
Comparative effects of rosuvastatin and gemfibrozil on glucose, insulin, and lipid metabolism in insulin-resistant, nondiabetic patients with combined dyslipidemia
Am J Cardiol
(2005) - et al.
Differing effect of statins on insulin sensitivity in non-diabetics: a systematic review and meta-analysis
Diabetes Res Clin Pract
(2010)
Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicenter randomized placebo-controlled trial
Lancet
Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials
Lancet
The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials
Lancet
Banting Memorial Lecture 2012: reversing the twin cycles of type 2 diabetes
Diabet Med
Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein
N Engl J Med
Statin therapy and risk of developing type 2 diabetes: a meta-analysis
Diabetes Care
Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis
JAMA
Pravastatin and the development of diabetes mellitus: evidence for a protective treatment effect in the West of Scotland Coronary Prevention Study
Circulation
Intensive lipid lowering with atorvastatin in patients with stable coronary disease
N Engl J Med
Cited by (11)
Neutral effect of SGLT2 inhibitors on lipoprotein metabolism: From clinical evidence to molecular mechanisms
2023, Pharmacological ResearchLipid-lowering in diabetes: An update
2023, AtherosclerosisHormonal therapy for breast cancer and diabetes incidence among postmenopausal women
2016, Annals of EpidemiologyCitation Excerpt :Since AIs interfere with the conversion of androgens to estrogen, this may be due to an increase in male gonadal hormones [22]. At the same time, statins are commonly prescribed for dyslipidemia and this class of medications is known to increase the risk of diabetes [23–30] thus explaining why a protective effect for AI users might be observed only among women without lipid disorder. Although AIs are now considered first-line therapy for hormone receptor positive breast cancer in the United States, both the National Comprehensive Cancer Network and the American Society of Clinical Oncology clinical guidelines outline several options for the upfront selection and sequencing of AIs and tamoxifen [5,7].
Association between cardiovascular diseases and apical periodontitis: an umbrella review
2020, International Endodontic JournalAssociation between diabetes and the outcome of root canal treatment in adults: an umbrella review
2020, International Endodontic Journal
This article originally appeared in Cardiology Clinics, Volume 33, Issue 2, May 2015.
Disclosures: Dr K.C. Maki discloses that in the past 12 months he has received consulting fees and/or research grants from AbbVie, Amarin, AstraZeneca, and Trygg Pharmaceuticals. Dr M.R. Dicklin has nothing to disclose. Dr S.J. Baum discloses that in the past 12 months he has received consulting/speaking fees from Aegerion, Genzyme, Sanofi, AstraZeneca, and Merck Pharmaceuticals.