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Statin Therapy Increases Diabetes Risk by 10%–36%, Find New Study

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A recent comprehensive study published in The Lancet Diabetes & Endocrinology has found that statin therapy is associated with a moderate, dose-dependent increase in the risk of new-onset diabetes and worsening glycaemia. The Cholesterol Treatment Trialists’ (CTT) Collaboration led the study, which sought to provide a deeper understanding of the timing, scope, and population-specific risks associated with statin-induced diabetes.

Statins are widely prescribed for their effectiveness in lowering LDL cholesterol, which significantly reduces the incidence of myocardial infarction and ischaemic stroke. However, previous meta-analyses have indicated an increased risk of diabetes associated with statin therapy. This new study delves into individual participant data from large, long-term, randomised, double-blind trials to clarify these associations.

The meta-analysis included data from 19 trials comparing statin therapy versus placebo and four trials comparing more intensive versus less intensive statin therapy. The total participant pool was 154,664, with a median follow-up of 4.4 years. Eligible trials had a minimum of 1,000 participants and a scheduled duration of at least two years. The study recorded diabetes-related adverse events, treatments, and measures of glycaemia.

The study found that low-intensity or moderate-intensity statin therapy led to a 10% proportional increase in new-onset diabetes. Specifically, 2,420 out of 39,179 participants on statins developed diabetes (1.3% per year) compared to 2,214 out of 39,266 participants on placebo (1.2% per year), with a rate ratio (RR) of 1.10 (95% CI 1.04–1.16).

For high-intensity statin therapy, the risk increased by 36%. In this group, 1,221 out of 9,935 participants on statins developed diabetes (4.8% per year) compared to 905 out of 9,859 participants on placebo (3.5% per year), with an RR of 1.36 (95% CI 1.25–1.48).

In participants without baseline diabetes, mean glucose levels increased by 0.04 mmol/L with both low-intensity and high-intensity statins, and mean HbA1c increased by 0.06% and 0.08%, respectively. Among those with baseline diabetes, the relative risk for worsening glycaemia was 1.10 (1.06–1.14) for low-intensity or moderate-intensity statin therapy and 1.24 (1.06–1.44) for high-intensity statin therapy.

The majority of new-onset diabetes cases were among participants who already had high baseline glycaemia markers, close to the diagnostic threshold for diabetes. Approximately 62% of new-onset diabetes cases occurred in participants in the highest quartile of baseline glycaemia. The study also found that the relative effects of statin therapy on new-onset diabetes were consistent across different types of participants, including variations by age, sex, and baseline cardiovascular risk factors.

These findings highlight the importance of monitoring glycaemia in patients undergoing statin therapy, particularly those on high-intensity regimens. While the absolute risk increase is small, the relative risk is significant enough to warrant consideration in clinical decision-making, especially for individuals with pre-existing risk factors for diabetes.

Despite these risks, the study reinforces that the cardiovascular benefits of statins outweigh the potential adverse effects related to glycaemia. The authors suggest that these findings should be integrated into clinical guidelines to better manage and monitor patients on statin therapy.

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