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Are statins diabetogenic?

Abstract

PURPOSE OF REVIEW

Statins are widely utilized for low-density lipoprotein lowering and for prevention of atherosclerotic cardiovascular disease. Although these drugs have a good safety record, increased risk of developing diabetes during extended use has recently garnered attention. Here we review clinical trial evidence related to statin use and incident diabetes, and the potential mechanisms for this association.

RECENT FINDINGS

The increased incidence of diabetes with rosuvastatin treatment in Justification for the Use of Statins in Primary Prevention: an intervention Trial Evaluating Rosuvastatin (JUPITER) reignited attention on the link between statin therapy and diabetes. The JUPITER findings are supported by two recent meta-analyses of large-scale placebo-controlled and standard care-controlled trials, which, respectively, observed a 9% [odds ratio 1.09; 95% confidence interval (CI) 1.02-1.17] and 13% (risk ratio 1.13; 95% CI 1.03-1.23) increased risk for incident diabetes associated with statin therapy. However, the underlying mechanisms for this association remain unclear. Experimental evidence supports a paradigm implicating inhibition of β-cell glucose transporters, delayed ATP production, pro-inflammatory and oxidative β-cell effects of plasma-derived cholesterol, inhibition of calcium channel-dependent insulin secretion, and β-cell apoptosis.

SUMMARY

The aggregate of large clinical trials supports the notion that statins modestly increase the risk of incident diabetes. Because diabetes is a risk equivalent condition for coronary and peripheral arterial diseases, these findings create a paradox whereby needed statin therapy may be withheld to avoid excess risk of diabetes while representing the strongest cardiovascular risk reduction tool in diabetics. We simply recommend regular glucose monitoring in patients taking statins.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-6300, USA. u.sampson@vanderbilt.edu

    ,

    Source

    Current opinion in cardiology 26:4 2011 Jul pg 342-7

    MeSH

    Blood Glucose
    Cardiovascular Diseases
    Diabetes Mellitus
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Hyperlipidemias
    Meta-Analysis as Topic
    Randomized Controlled Trials as Topic
    Risk Factors

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    21499090

    Citation

    Sampson, Uchechukwu K., et al. "Are Statins Diabetogenic?" Current Opinion in Cardiology, vol. 26, no. 4, 2011, pp. 342-7.
    Sampson UK, Linton MF, Fazio S. Are statins diabetogenic? Curr Opin Cardiol. 2011;26(4):342-7.
    Sampson, U. K., Linton, M. F., & Fazio, S. (2011). Are statins diabetogenic? Current Opinion in Cardiology, 26(4), pp. 342-7. doi:10.1097/HCO.0b013e3283470359.
    Sampson UK, Linton MF, Fazio S. Are Statins Diabetogenic. Curr Opin Cardiol. 2011;26(4):342-7. PubMed PMID: 21499090.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Are statins diabetogenic? AU - Sampson,Uchechukwu K, AU - Linton,Macrae F, AU - Fazio,Sergio, PY - 2011/4/19/entrez PY - 2011/4/19/pubmed PY - 2011/11/16/medline SP - 342 EP - 7 JF - Current opinion in cardiology JO - Curr. Opin. Cardiol. VL - 26 IS - 4 N2 - PURPOSE OF REVIEW: Statins are widely utilized for low-density lipoprotein lowering and for prevention of atherosclerotic cardiovascular disease. Although these drugs have a good safety record, increased risk of developing diabetes during extended use has recently garnered attention. Here we review clinical trial evidence related to statin use and incident diabetes, and the potential mechanisms for this association. RECENT FINDINGS: The increased incidence of diabetes with rosuvastatin treatment in Justification for the Use of Statins in Primary Prevention: an intervention Trial Evaluating Rosuvastatin (JUPITER) reignited attention on the link between statin therapy and diabetes. The JUPITER findings are supported by two recent meta-analyses of large-scale placebo-controlled and standard care-controlled trials, which, respectively, observed a 9% [odds ratio 1.09; 95% confidence interval (CI) 1.02-1.17] and 13% (risk ratio 1.13; 95% CI 1.03-1.23) increased risk for incident diabetes associated with statin therapy. However, the underlying mechanisms for this association remain unclear. Experimental evidence supports a paradigm implicating inhibition of β-cell glucose transporters, delayed ATP production, pro-inflammatory and oxidative β-cell effects of plasma-derived cholesterol, inhibition of calcium channel-dependent insulin secretion, and β-cell apoptosis. SUMMARY: The aggregate of large clinical trials supports the notion that statins modestly increase the risk of incident diabetes. Because diabetes is a risk equivalent condition for coronary and peripheral arterial diseases, these findings create a paradox whereby needed statin therapy may be withheld to avoid excess risk of diabetes while representing the strongest cardiovascular risk reduction tool in diabetics. We simply recommend regular glucose monitoring in patients taking statins. SN - 1531-7080 UR - https://www.unboundmedicine.com/medline/citation/21499090/Are_statins_diabetogenic L2 - http://Insights.ovid.com/pubmed?pmid=21499090 DB - PRIME DP - Unbound Medicine ER -