Thursday, January 12, 2012

Statins And Risk of Developing Type 2 Diabetes

A new large study this week reported that postmenopausal women who took any statin had a 48% greater risk of developing diabetes:

Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative, Archives of Internal Medicine

It included 153,840 women from the the Women's Health Initiative. The risk remained after adjustment for confounders such as family history of diabetes, body mass index, physical activity, and a "propensity score" (women who were already at risk for developing diabetes).

The study's lead author, Annie Culver, said:
"It's still an area under scrutiny. ... Statins may affect the way the body manages insulin and glucose responses."
- Statins May Boost Diabetes Risk in Older Women

A meta-analysis or study of studies was published in 2009 which hinted at this link:

Statin Therapy and Risk of Developing Type 2 Diabetes: A Meta-Analysis, Diabetes Care, 2009

This analysis looked at six studies:
  • West of Scotland Coronary Prevention Study (WOSCOPS)
  • Heart Protection Study (HPS)
  • Long-Term Intervention with Pravastatin in Ischemic Disease Study (LIPID)
  • Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)
  • Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER)
  • Controlled Rosuvastatin Multinational Study in Heart Failure (CORONA)

The bottom 5 studies, when taken together, revealed "a small but statistically significant increase in diabetes incidence" associated with statin use. The increased risk did not appear to be drug- or dose-specific. The association was no longer significant when the first study (WOSCOPS) was included: (Click to enlarge.)

The authors concluded:
"We found no evidence for a protective role of statin treatment on incident diabetes but rather observed a small but significant increase in risk. By contrast, this effect was attenuated and no longer significant in a meta-analysis that included all available evidence, including the original hypothesis-generating data.

Although statin therapy greatly lowers vascular risk, including among those with and at risk for diabetes, the relationship of statin therapy to incident diabetes remains uncertain."