Statins are 'well tolerated and safe drugs' known for their efficacy in reducing fatal and nonfatal Coronary Heart Disease (CHD) events, strokes, and total mortality. They are the most effective agents available for treating dyslipidemia (includes hyperlipidemia or hypercholesterolemia). They act by inhibiting an enzyme (called HMG CoA Reductase) involved in the synthesis of cholesterol. Common statins in use include Atorvastatin, Fluvastatin, Rosuvastatin, Pravastatin and Simvastatin.
Shadows of suspicion have however fallen on the safety of long-term use of statins after conflicting reports of development of diabetes in patients taking these agents was revealed by research publications.
AdvertisementIn one of the trials adults with no clinical or biochemical diagnosis of diabetes developed the ailment after the initiation of therapy with a statin called Rosuvastatin. The question about the safety of statins is of great public health importance owing to the large prevalence of dyslipidemia and coronary heart diseases.
A meta-analysis of all available published and unpublished data from large placebo-controlled and standard-care-controlled statin trials was performed to learn if statin use can cause diabetes. Medline, Embase, and the Cochrane Central Register of Controlled Trials, from 1994 to 2009, were searched. Results were published in Lancet 2010; 375: 735-42.
13 statin trials with 91 140 participants were identified. Out of these 91 140 participants, 4278 (2226 assigned statins and 2052 assigned control treatment) developed diabetes after a mean follow up of 4 years. This meant that statin therapy was associated with a 9% increased risk for incident diabetes.
Statin therapy is associated with a slightly increased risk of development of diabetes. Data suggest that older men on statin should be evaluated for diabetes on follow up. The benefit of statins for reduction of cardiovascular events is much higher, and this outweighs the tiny absolute risk of developing diabetes.
As the benefits outweigh the risks, the clinical practice for statin therapy need not be changed for patients with moderate or high cardiovascular risk or existing cardiovascular disease. However the increased diabetes risk may be considered for patients at low cardiovascular risk before switching to statin therapy.
Reference: Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials; Lancet2010; 375: 735-42