Statins and New-Onset Diabetes: Who Is at Risk?

Mr James is 58 years old, has a history of hypertension, and family history of premature coronary artery disease. He smokes half to one pack of cigarettes per day. His father, who was also a smoker, had a 2-vessel CABG at the age of 53 years. He currently takes hydrochlorothiazide 25 mg and lisinopril 5 mg. He comes in today for his annual check-up.  A fasting lipid panel reveals: total cholesterol, 252 mg/dL; triglycerides, 143 mg/dL; VLDL-C,  29 mg/dL; LDL-C, 185 mg/dL; and HDL-C, 38 mg/dL. Blood pressure is 132/66 mm Hg; BMI is 31 kg/m²; fasting blood glucose is 125 mg/dL. The remainder of his examination is unremarkable.

You determine that based on the ACC/AHA Pooled Cohort Risk Estimator, Mr James meets the indication for high-intensity statin therapy, since his 10-year estimated risk for a first atherosclerotic cardiovascular disease–related event is 22.7%.

Your recommendation is that he begin therapy with a high-potency statin medication. Mr James tells you he’s heard about the risk of “becoming a diabetic” in patients taking statins and is hesitant to agree to the new medication.

What should you tell Mr James about high-potency statin therapy and risk for new-onset diabetes (NOD)? (Choose all that apply)

A. There is no increased risk for NOD in anyone who begins statin therapy, regardless of baseline fasting blood glucose level

B. Everyone who starts statin therapy has the same increase in risk for NOD, regardless of baseline fasting blood glucose level

C. The risk for NOD is higher with high- compared with moderate-intensity statin therapy

D. Those with impaired fasting glucose tolerance have a higher risk of NOD with statin therapy compared with those without impaired fasting blood glucose at baseline.

Please select an answer and leave a comment if you’d like.

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