Statin treatment and diabetes risk

A meta-analysis into the risk of diabetes associated with statin use has been undertaken (1):

• statin therapy was associated with a 9% increased risk for incident diabetes (odds ratio [OR] 1.09; 95% CI 1.02-1.17), with little heterogeneity (I(2)=11%) between trials
• meta-regression showed that risk of development of diabetes with statins was highest in trials with older participants, but neither baseline body-mass index nor change in LDL-cholesterol concentrations accounted for residual variation in risk
• treatment of 255 (95% CI 150-852) patients with statins for 4 years resulted in one extra case of diabetes.

Statin therapy in adult women: risk of diabetes versus cardiovascular benefit

• review of the literature indicates that the cardiovascular benefits of statins appear to outweigh the risk for statin-related diabetes (2)

NICE have stated "..Do not stop statins because of an increase in blood glucose level or HbA1c.."

In the REPRIEVE trial (randomized trial to prevent vascular events in HIV) (4):

• trial was stopped early for efficacy after a median follow-up of 5.1 years
• participants with at least 3 diabetes mellitus risk factors (vs. no risk factors) had increased risk for diabetes mellitus in each treatment group (incidence rate, 3.24 per 100 person-years [PY] vs. 0.34 per 100 PY [pitavastatin] and 2.66 per 100 PY vs. 0.27 per 100 PY [placebo])
• incidence of diabetes mellitus was highest in South Asia. In adjusted analyses, high body mass index, prediabetes, and metabolic syndrome components were strongly associated with new-onset DM (all P < 0.005)
• study authors concluded that:
  • metabolic risk factors, including prediabetes and obesity, contributed to new-onset diabetes in statin- and placebo-treated participants.
  • a clinically significant effect of pitavastatin on diabetes was seen primarily among those with multiple risk factors for diabetes at entry

Reference:

• 1) Sattar N et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010 Feb 27;375(9716):735-42. Epub 2010 Feb 16
• 2) Ma Y et al. Statin therapy and the risk for diabetes among adult women: do the benefits outweigh the risk? Ther Adv Cardiovasc Dis. 2012 Dec 13.
• 3) NICE (July 2014). Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease
• 4) Fitch KV et al. Diabetes Risk Factors in People With HIV Receiving Pitavastatin Versus Placebo for Cardiovascular Disease Prevention: A Randomized Trial. Ann Intern Med.[Epub 8 October 2024]