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Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials.

Abstract

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 We aimed to establish by a meta-analysis of published and unpublished data whether any relation exists between statin use and development of diabetes.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.

FINDINGS

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.

INTERPRETATION

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.

FUNDING

None.

Links

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  • Authors+Show Affiliations

    ,

    British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK. nsattar@clinmed.gla.ac.uk

    , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

    Source

    Lancet (London, England) 375:9716 2010 Feb 27 pg 735-42

    MeSH

    Age Distribution
    Age Factors
    Aged
    Anticholesteremic Agents
    Cardiovascular Diseases
    Diabetes Mellitus, Type 2
    Female
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Male
    Middle Aged
    Randomized Controlled Trials as Topic
    Risk Factors
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    20167359

    Citation

    Sattar, Naveed, et al. "Statins and Risk of Incident Diabetes: a Collaborative Meta-analysis of Randomised Statin Trials." Lancet (London, England), vol. 375, no. 9716, 2010, pp. 735-42.
    Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375(9716):735-42.
    Sattar, N., Preiss, D., Murray, H. M., Welsh, P., Buckley, B. M., de Craen, A. J., ... Ford, I. (2010). Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet (London, England), 375(9716), pp. 735-42. doi:10.1016/S0140-6736(09)61965-6.
    Sattar N, et al. Statins and Risk of Incident Diabetes: a Collaborative Meta-analysis of Randomised Statin Trials. Lancet. 2010 Feb 27;375(9716):735-42. PubMed PMID: 20167359.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. AU - Sattar,Naveed, AU - Preiss,David, AU - Murray,Heather M, AU - Welsh,Paul, AU - Buckley,Brendan M, AU - de Craen,Anton J M, AU - Seshasai,Sreenivasa Rao Kondapally, AU - McMurray,John J, AU - Freeman,Dilys J, AU - Jukema,J Wouter, AU - Macfarlane,Peter W, AU - Packard,Chris J, AU - Stott,David J, AU - Westendorp,Rudi G, AU - Shepherd,James, AU - Davis,Barry R, AU - Pressel,Sara L, AU - Marchioli,Roberto, AU - Marfisi,Rosa Maria, AU - Maggioni,Aldo P, AU - Tavazzi,Luigi, AU - Tognoni,Gianni, AU - Kjekshus,John, AU - Pedersen,Terje R, AU - Cook,Thomas J, AU - Gotto,Antonio M, AU - Clearfield,Michael B, AU - Downs,John R, AU - Nakamura,Haruo, AU - Ohashi,Yasuo, AU - Mizuno,Kyoichi, AU - Ray,Kausik K, AU - Ford,Ian, Y1 - 2010/02/16/ PY - 2010/2/20/entrez PY - 2010/2/20/pubmed PY - 2010/3/17/medline SP - 735 EP - 42 JF - Lancet (London, England) JO - Lancet VL - 375 IS - 9716 N2 - 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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: None. SN - 1474-547X UR - https://www.unboundmedicine.com/medline/citation/20167359/Statins_and_risk_of_incident_diabetes:_a_collaborative_meta_analysis_of_randomised_statin_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(09)61965-6 DB - PRIME DP - Unbound Medicine ER -