Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials.
BACKGROUND
Trials of statin therapy have had conflicting findings on the risk of development of diabetes mellitus in patients given statins. We aimed to establish by a meta-analysis of published and unpublished data whether any relation exists between statin use and development of diabetes.


METHODS
We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1994 to 2009, for randomised controlled endpoint trials of statins. We included only trials with more than 1000 patients, with identical follow-up in both groups and duration of more than 1 year. We excluded trials of patients with organ transplants or who needed haemodialysis. We used the I(2) statistic to measure heterogeneity between trials and calculated risk estimates for incident diabetes with random-effect meta-analysis.


RESULTS
We identified 13 statin trials with 91 140 participants, of whom 4278 (2226 assigned statins and 2052 assigned control treatment) developed diabetes during a mean of 4 years. Statin therapy was associated with a 9% increased risk for incident diabetes (odds ratio [OR] 1.09; 95% CI 1.02-1.17), with little heterogeneity (I(2)=11%) between trials. Meta-regression showed that risk of development of diabetes with statins was highest in trials with older participants, but neither baseline body-mass index nor change in LDL-cholesterol concentrations accounted for residual variation in risk. Treatment of 255 (95% CI 150-852) patients with statins for 4 years resulted in one extra case of diabetes.


CONCLUSIONS
Statin therapy is associated with a slightly increased risk of development of diabetes, but the risk is low both in absolute terms and when compared with the reduction in coronary events. Clinical practice in patients with moderate or high cardiovascular risk or existing cardiovascular disease should not change.


BACKGROUND
None.
Sattar
Naveed
N
British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. nsattar@clinmed.gla.ac.uk
Preiss
David
D
Murray
Heather M
HM
Welsh
Paul
P
Buckley
Brendan M
BM
de Craen
Anton J M
AJ
Seshasai
Sreenivasa Rao Kondapally
SR
McMurray
John J
JJ
Freeman
Dilys J
DJ
Jukema
J Wouter
JW
Macfarlane
Peter W
PW
Packard
Chris J
CJ
Stott
David J
DJ
Westendorp
Rudi G
RG
Shepherd
James
J
Davis
Barry R
BR
Pressel
Sara L
SL
Marchioli
Roberto
R
Marfisi
Rosa Maria
RM
Maggioni
Aldo P
AP
Tavazzi
Luigi
L
Tognoni
Gianni
G
Kjekshus
John
J
Pedersen
Terje R
TR
Cook
Thomas J
TJ
Gotto
Antonio M
AM
Clearfield
Michael B
MB
Downs
John R
JR
Nakamura
Haruo
H
Ohashi
Yasuo
Y
Mizuno
Kyoichi
K
Ray
Kausik K
KK
Ford
Ian
I
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000924:Anticholesteremic Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors