Cardiovascular benefits with statins outweigh diabetes risk

There is a small absolute risk of diabetes mellitus (DM) in patients who receive statin therapy, but that risk is easily outweighed by the benefit that statins provide in reducing cardiovascular (CV) events. Therefore, clinical practice does not need to change for patients with moderate or high CV risk or existing CV disease.

Sattar and colleagues performed a meta-analysis of all available data from 13 large statin trials. There were 91,140 participants.

DM developed in a total of 4278 participants (2226 taking statins and 2052 controls) over 4 years. Thus, the risk of DM increased by about 9% in statin-treated persons versus others, regardless of whether their statin was lipophilic or hydrophilic. The risk increased with age but was unrelated to body mass index or changes in low-density lipoprotein concentration. The explanation for these findings remains elusive but could lie in a molecular mechanism, confounding factors (eg, increased survival in persons taking statins), or a direct effect of statins on insulin resistance.

The authors noted that the potentially elevated DM risk should be taken into account if statin therapy is considered for patients with low CV risk or those for whom CV risk has not been proved.