title: Cardiovascular event reduction versus new-onset diabetes during atorvastatin therapy: effect of baseline risk factors for diabetes.
abstract: OBJECTIVE
  The purpose of this study was to compare the incidence of new-onset diabetes (NOD) with cardiovascular (CV) event reduction at different levels of NOD risk.
  
  
  BACKGROUND
  Statins reduce the number of CV events but increase the incidence of NOD. We previously reported that 4 factors independently predicted NOD: fasting blood glucose >100 mg/dl, fasting triglycerides >150 mg/dl, body mass index >30 kg/m(2), and history of hypertension.
  
  
  METHODS
  We compared NOD incidence with CV event reduction among 15,056 patients with coronary disease but without diabetes at baseline in the TNT (Treating to New Targets) (n = 7,595) and IDEAL (Incremental Decrease in Endpoints Through Aggressive Lipid Lowering) (n = 7,461) trials. CV events included coronary heart disease death, myocardial infarction, stroke, and resuscitated cardiac arrest.
  
  
  RESULTS
  Among 8,825 patients with 0 to 1 of the aforementioned NOD risk factors at baseline, NOD developed in 142 of 4,407 patients in the atorvastatin 80 mg group and in 148 of 4,418 in the atorvastatin 10 mg and simvastatin 20 to 40 mg groups (3.22% vs. 3.35%; hazard ratio [HR]: 0.97; 95% confidence intervals [CI]: 0.77 to 1.22). Among the remaining 6,231 patients with 2 to 4 NOD risk factors, NOD developed in 448 of 3,128 in the atorvastatin 80 mg group and in 368 of 3,103 in the lower-dose groups (14.3% vs. 11.9%; HR: 1.24; 95% CI: 1.08 to 1.42; p = 0.0027). The number of CV events was significantly reduced with atorvastatin 80 mg in both NOD risk groups.
  
  
  CONCLUSIONS
  Compared with lower-dose statin therapy, atorvastatin 80 mg/day did not increase the incidence of NOD in patients with 0 to 1 NOD risk factors but did, by 24%, among patients with 2 to 4 NOD risk factors. The number of CV events was significantly reduced with atorvastatin 80 mg in both NOD risk groups.
authors.affiliation: Division of Cardiology, San Francisco General Hospital and University of California at San Francisco, San Francisco, California 94114, USA. dwaters@medsfgh.ucsf.edu
authors.forename: David D
authors.initials: DD
authors.lastname: Waters
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Ho
authors.forename: S Matthijs
authors.initials: SM
authors.lastname: Boekholdt
authors.forename: David A
authors.initials: DA
authors.lastname: DeMicco
authors.forename: John J P
authors.initials: JJ
authors.lastname: Kastelein
authors.forename: Michael
authors.initials: M
authors.lastname: Messig
authors.forename: Andrei
authors.initials: A
authors.lastname: Breazna
authors.forename: Terje R
authors.initials: TR
authors.lastname: Pedersen
mesh_terms: D000328:Adult; D000368:Aged; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000517:prevention & control; D006538:Heptanoic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D011758:Pyrroles / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D019821:Simvastatin / Q000008:administration & dosage* / Q000009:adverse effects; D020521:Stroke / Q000517:prevention & control
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin