JAMA. 2011 Jun 22;305(24):2556-64.
Risk of incident diabetes with intensive-dose compared with moderate-
dose statin therapy: a meta-analysis.
CONTEXT:
A recent meta-analysis demonstrated that statin therapy is associated
with excess risk of developing diabetes mellitus.
OBJECTIVE:
To investigate whether intensive-dose statin therapy is associated
with increased risk of new-onset diabetes compared with moderate-dose
statin therapy.
DATA SOURCES:
We identified relevant trials in a literature search of MEDLINE,
EMBASE, and the Cochrane Central Register of Controlled Trials
(January 1, 1996, through March 31, 2011). Unpublished data were
obtained from investigators.
STUDY SELECTION:
We included randomized controlled end-point trials that compared
intensive-dose statin therapy with moderate-dose statin therapy and
included more than 1000 participants who were followed up for more
than 1 year.
DATA EXTRACTION:
Tabular data provided for each trial described baseline
characteristics and numbers of participants developing diabetes and
experiencing major cardiovascular events (cardiovascular death,
nonfatal myocardial infarction or stroke, coronary revascularization).
We calculated trial-specific odds ratios (ORs) for new-onset diabetes
and major cardiovascular events and combined these using random-
effects model meta-analysis. Between-study heterogeneity was assessed
using the I(2) statistic.
RESULTS:
In 5 statin trials with 32,752 participants without diabetes at
baseline, 2749 developed diabetes (1449 assigned intensive-dose
therapy, 1300 assigned moderate-dose therapy, representing 2.0
additional cases in the intensive-dose group per 1000 patient-years)
and 6684 experienced cardiovascular events (3134 and 3550,
respectively, representing 6.5 fewer cases in the intensive-dose group
per 1000 patient-years) over a weighted mean (SD) follow-up of 4.9
(1.9) years. Odds ratios were 1.12 (95% confidence interval [CI],
1.04-1.22; I(2) = 0%) for new-onset diabetes and 0.84 (95% CI,
0.75-0.94; I(2) = 74%) for cardiovascular events for participants
receiving intensive therapy compared with moderate-dose therapy. As
compared with moderate-dose statin therapy, the number needed to harm
per year for intensive-dose statin therapy was 498 for new-onset
diabetes while the number needed to treat per year for intensive-dose
statin therapy was 155 for cardiovascular events.
CONCLUSION:
In a pooled analysis of data from 5 statin trials, intensive-dose
statin therapy was associated with an increased risk of new-onset
diabetes compared with moderate-dose statin therapy.
PMID: 21693744 [PubMed - indexed for MEDLINE]
