Statins And Diabetes Should We Be Worried

Statins and diabetes should we be worried - On February 28, 2012, Drug and food Supervisory Agency of USA (FDA) update its labeling requirements for statins. In addition to revising his recommendation to monitor liver function and warning about reports of memory loss, the FDA also warned of the possibility of new onset diabetes mellitus and glycemic control is worse in patients taking statins drugs. 1

These changes sparked ongoing debate about the risks of diabetes with the use of statins and the implications of such an effect. To understand the clinical consequences of this warning and its influence on treatment decisions, we need to consider the extent to which Statins lower the risk of cardiovascular disease in patients at high risk (including diabetic patients), the magnitude of the the risk of developing diabetes recently while on statin therapy, and the ratio of risk against the benefits on the treated population.

What is Statins Can Caused Diabetes?

Controlled trials individually since more than a decade have conflicting results about new diabetes and control diabetes worse in patients taking statins.

The West of Scotland Coronary Prevention Study (WOSCOPS) 2 propose that the rate of diabetes was 30% lower in patients utilizing pravastatin (Pravachol) 40 mg/day contrasted and fake treatment. Statins and diabetes should we be worried - However, this was not observed with atorvastatin (Lipitor) 10 mg/day in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-lowering Arm (ASCOT-LLA) 3 in patients of hypertension or Diabetes Atorvastatin Collaboration in the study (CARDS) 4 in diabetes patients, 4 also not recorded with simvastatin (Zocor) 40 mg/day for heart Protection study (HPS).

Justification for the use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), 6 use of rosuvastatin (Crestor) agents are a more powerful 20 mg/day in patients with elevated levels of C-reactive protein (CRP), terminated early when the provisional analysis found 44% lower incidence of primary endpoint. However, these trials also reported a 26% higher diabetes during follow-up of fewer than two years.

In a prospective study of Pravastatin in the Elderly at risk (PROSPER), 7 with an average age of 75, there are entries on the incidence of diabetes 32% higher with pravastatin therapy.

The Results of a meta-analysis

Several meta-analyses have discussed these differences.

Rajpathak et al 8 did a meta-analysis, published in 2009, of the six experiments — WOSCOPS, the ASCOT-LLA, 2 3 JUPITER, 6 5 HPS study Long-term Intervention With Pravastatin in Ischemic Disease (LIPID), 9 and the multinational study of Rosuvastatin Unrestrained in heart failure (CORONA), 10dengan 57,593 total patients. Statins and diabetes should we be worried - They calculate that the incidence of diabetes was 13% higher absolute difference (0.5%) on the recipient of the statins, which are statistically significant. In their initial analysis, the author exempts WOSCOPS, described it as a producer of the hypothesis. The relative increase in the risk of less-6%-and is not statistically significant when WOSCOPS entered.

Sattar et al, 11 in a meta-analysis of a larger, published in 2010, including 91,140 participants in 13 major statin trial conducted between 1994 and 2009; every experiment have more than 1,000 patients and over 1 year period of follow-up. 2, 3, 5 .10 -7,9, 12-17 new Diabetes is defined as doctors reported new diabetes, diabetes drug use recently, or fasting glucose greater than 7 mmol/L (126 mg/dL).

New diabetes occurs at 2,226 (4.89%) of recipients of statins and at 2,052 (4.5%) than placebo recipients, the absolute difference of 0.39%, or 9% more (odds ratio [OR] 1.09; 95% confidence interval [CI]] 1.02 – 1.17).

Incident diabetes varied substantially among the 13 experiments, with only JUPITER 6 and 7 that found increased PROSPER numbers statistically significant (respectively 26% and 32%). Statins and diabetes should we be worried - Of the 11 other experiments, 4 tendencies have not signed to lower incidence, 2, 9, 13, 17 while the other 7 have no significant trend towards a higher incidence.

What are the specific Statins make a difference?

The question asked is whether the type of statin use, the intensity of therapy, or the population researched contributed to this distinction. Various studies indicate that factors such as the use of hydrophilic vs lipophilic Statins (pravastatin include hydrophilic statins and lipophilic statin rosuvastatin; including atorvastatin, lovastatin, and simvastatin), dose, rate the drop in low-density lipoprotein cholesterol (LDL-C), and age or clinical characteristics of the population examined may affect this relationship. 18 – 20

Yamakawa et al. 18 researching effects of atorvastatin 10 mg/day, pravastatin 10 mg/day, pitavastatin (Livalo) and 2 mg/day on the glycemic control for 3 months in a retrospective analysis. Random blood glucose levels and hemoglobin A 1 c rise on atorvastatin group but not on the other two. 18

A prospective comparison of atorvastatin 20 mg vs pitavastatin 4 mg in patients with type 2 diabetes, presented at the annual meeting of the American College of Cardiology 2011, reported a significant increase in fasting glucose levels with atorvastatin, especially in women, but not with pitavastatin. 19

In comparing the influence of Rosuvastatin With Atorvastatin on Apo B/Apo A-1 ratio in patients with type 2 Diabetes Mellitus and Other (CORAL) study, 20 both rosuvastatin high doses (40 mg) and high-dose atorvastatin (80 mg)) associated with a significant increase in hemoglobin A 1 c, although fasting glucose levels averaging does not differ significantly at 18 weeks of therapy.

A meta-analysis by Sattar et al 11 found no clear differences between lipophilic Statins (OR 1.10 vs. placebo) and a hydrophilic statin (OR 1.08). In the analysis based on the type of statin, rosuvastatin combination test statistically significant in favor of the higher diabetes risk (OR 1.18, 95% CI 1.04-1,44). Statins and diabetes should we be worried - The trend is not significant are noted for atorvastatin trials (OR 1.14) and simvastatin (OR 1.11) and less to pravastatin (OR 1.03); Or for lovastatin was 0.98. This may indicate that there is a stronger effect with a more powerful Statins or with a decrease in LDL-C.

Regression analysis of the met – in this study indicates that the risk of diabetes by statins was higher in patients who are older but not influenced by body mass index or the extent to which LDL-C was revealed.