title: Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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 Unpublished data were obtained from investigators.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Pl, Glasgow G12 8TA, Scotland, United Kingdom. david.preiss@glasgow.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Preiss
authors.forename: Sreenivasa Rao Kondapally
authors.initials: SR
authors.lastname: Seshasai
authors.forename: Paul
authors.initials: P
authors.lastname: Welsh
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Murphy
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Ho
authors.forename: David D
authors.initials: DD
authors.lastname: Waters
authors.forename: David A
authors.initials: DA
authors.lastname: DeMicco
authors.forename: Philip
authors.initials: P
authors.lastname: Barter
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Marc S
authors.initials: MS
authors.lastname: Sabatine
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.forename: John J P
authors.initials: JJ
authors.lastname: Kastelein
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Michael A
authors.initials: MA
authors.lastname: Blazing
authors.forename: Terje R
authors.initials: TR
authors.lastname: Pedersen
authors.forename: Matti J
authors.initials: MJ
authors.lastname: Tikkanen
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012306:Risk
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors