Higher-potency statins associated with more new diabetes cases

Patients taking higher-potency statins for secondary prevention are more likely to develop diabetes than those on lower-potency statins, a recent study found.

The multicenter observational study included more than 130,000 U.S., Canadian, and British patients who were started on a statin after hospitalization for a major cardiovascular event or procedure. They were all 40 years of age or older and were first prescribed a statin between January 1997 and March 2011. The main outcome was new onset of diabetes, measured by a hospitalization for diabetes or a prescription for insulin or an oral antidiabetic drug. None of the patients had been diagnosed with diabetes as of their initial cardiac hospitalization.

The patients taking higher-potency statins had a significantly higher risk of developing diabetes in the first 2 years of taking the drugs (rate ratio [RR] compared to lower-potency users, 1.15; 95% CI, 1.05 to 1.26). The risk difference was greatest in the first 4 months of use (RR, 1.26; 95% CI, 1.07 to 1.47). Results were published by BMJ on May 29.

Use of higher-potency statins instead of lower-potency ones is associated with a moderate increase in diabetes risk in this secondary prevention population, the study authors concluded. These results are similar to those of some other meta-analyses and have plausible mechanisms to explain them. Some experts argue that the increased risk of diabetes is outweighed by greater protection against cardiovascular events with the higher-potency drugs, but their data come from trials that were not specifically designed to record diabetes events, the authors said.

Head-to-head comparisons of higher- and lower-potency statins have shown no difference in mortality or serious adverse events, so given this lack of benefit, clinicians should consider the risk of diabetes when choosing a statin for secondary prevention of cardiovascular disease, the authors concluded.