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Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis.

Abstract

CONTEXT

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.

DATA SOURCES

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 Unpublished data were obtained from investigators.

STUDY SELECTION

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.

DATA EXTRACTION

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.

CONCLUSION

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.

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  • Authors+Show Affiliations

    ,

    BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Pl, Glasgow G12 8TA, Scotland, United Kingdom. david.preiss@glasgow.ac.uk

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

    Source

    JAMA 305:24 2011 Jun 22 pg 2556-64

    MeSH

    Cardiovascular Diseases
    Diabetes Mellitus
    Dose-Response Relationship, Drug
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Odds Ratio
    Randomized Controlled Trials as Topic
    Risk

    Pub Type(s)

    Journal Article
    Meta-Analysis

    Language

    eng

    PubMed ID

    21693744

    Citation

    Preiss, David, et al. "Risk of Incident Diabetes With Intensive-dose Compared With Moderate-dose Statin Therapy: a Meta-analysis." JAMA, vol. 305, no. 24, 2011, pp. 2556-64.
    Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305(24):2556-64.
    Preiss, D., Seshasai, S. R., Welsh, P., Murphy, S. A., Ho, J. E., Waters, D. D., ... Ray, K. K. (2011). Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA, 305(24), pp. 2556-64. doi:10.1001/jama.2011.860.
    Preiss D, et al. Risk of Incident Diabetes With Intensive-dose Compared With Moderate-dose Statin Therapy: a Meta-analysis. JAMA. 2011 Jun 22;305(24):2556-64. PubMed PMID: 21693744.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. AU - Preiss,David, AU - Seshasai,Sreenivasa Rao Kondapally, AU - Welsh,Paul, AU - Murphy,Sabina A, AU - Ho,Jennifer E, AU - Waters,David D, AU - DeMicco,David A, AU - Barter,Philip, AU - Cannon,Christopher P, AU - Sabatine,Marc S, AU - Braunwald,Eugene, AU - Kastelein,John J P, AU - de Lemos,James A, AU - Blazing,Michael A, AU - Pedersen,Terje R, AU - Tikkanen,Matti J, AU - Sattar,Naveed, AU - Ray,Kausik K, PY - 2011/6/23/entrez PY - 2011/6/23/pubmed PY - 2011/6/28/medline SP - 2556 EP - 64 JF - JAMA JO - JAMA VL - 305 IS - 24 N2 - CONTEXT: 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. DATA SOURCES: 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. STUDY SELECTION: 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. DATA EXTRACTION: 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. CONCLUSION: 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. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/21693744/Risk_of_incident_diabetes_with_intensive_dose_compared_with_moderate_dose_statin_therapy:_a_meta_analysis_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2011.860 DB - PRIME DP - Unbound Medicine ER -