Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis

SPS commentary:

Of the trials analysed, 19 compared a statin with placebo in 123,940 participants (21% with diabetes) followed up for median of 4.3 years, and 4 trials compared more with less intensive statin therapy in 30,724 participants (17% with diabetes), followed up for median of 4.9 years. The researchers point out that any theoretical adverse effects of statins on cardiovascular risk that might arise from these small increases in glycaemia are already accounted for in the overall reduction in cardiovascular risk that is seen with statin therapy in these trials.

A commentary discusses how clinicians should interpret these findings. It notes that the decreased absolute annual incidence of life-threatening cardiovascular outcomes with statins in people at high risk clearly exceeds the 0·1–1·3% per year increased absolute incidence of type 2 diabetes. It adds that though any effect of a glucose-mediated increase in cardiovascular outcomes is captured in the trials, long-term effects following trials are uncertain. Nevertheless, it suggests the modest glucometabolic harm is unlikely to exceed the cardiovascular benefits of statins. It also highlights that the findings emphasise the importance of holistic care, as people at risk for cardiovascular outcomes are also at risk for type 2 diabetes, so any prescription of a statin should be accompanied by promoting proven strategies to prevent or delay diabetes, such as modest weight reduction and increased physical activity. It concludes that the findings emphasise the importance of always being alert for harmful adverse effects, even with the most beneficial and successful preventive therapies.