Differing effect of statins on insulin sensitivity in non-diabetics: a systematic review and meta-analysis.
BACKGROUND
To determine whether individual statins had differing effects on insulin sensitivity (IS) in patients without pre-existing diabetes mellitus.


METHODS
A systematic literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted through December 2008. Trials were included if they compared pravastatin, atorvastatin, rosuvastatin or simvastatin to placebo/control, excluded patients with diabetes, and reported data on insulin sensitivity/resistance. IS data was pooled and evaluated as standardized mean differences (SMDs) and 95% confidence interval (CI) using a random-effects model.


RESULTS
16 studies (n=1146) were included, with patients receiving pravastatin in three trials (n=164), atorvastatin in five trials (n=315), rosuvastatin in five trials (n=419), and simvastatin in five trials (n=369). When pooled as a class, statins had no significant impact on IS as compared with placebo/control [SMD -0.084 (95% CI -0.210 to 0.042); p=0.19]. Pravastatin was found to significantly improved IS [SMD 0.342 (95% CI 0.032-0.621); p=0.03], whereas simvastatin significantly worsened IS [SMD -0.321 (95% CI -0.526 to -0.117); p=0.03].


CONCLUSIONS
Statins do not appear to demonstrate a 'class effect' on IS in patients without diabetes. Differences between individual statins likely exist that may partially explain the findings of previously conducted meta-analyses examining the impact of statins on the development of diabetes.
Baker
William L
WL
University of Connecticut School of Pharmacy, Storrs, CT, USA. ccolema@harthosp.org
Talati
Ripple
R
White
C Michael
CM
Coleman
Craig I
CI
D000924:Anticholesteremic Agents / Q000494:pharmacology*; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D049628:Body Size; D005260:Female; D005464:Fluorobenzenes / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D007328:Insulin / Q000502:physiology*; D007333:Insulin Resistance; D008297:Male; D018579:Patient Selection; D017035:Pravastatin / Q000494:pharmacology / Q000627:therapeutic use; D011743:Pyrimidines / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000068718:Rosuvastatin Calcium; D019821:Simvastatin / Q000494:pharmacology / Q000627:therapeutic use; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood
D000924:Anticholesteremic Agents; D001786:Blood Glucose; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007328:Insulin; D011743:Pyrimidines; D013449:Sulfonamides; D014280:Triglycerides; D000068718:Rosuvastatin Calcium; D019821:Simvastatin; D017035:Pravastatin