Readers may recall previous discussions of the potential for statin treatment leading to diabetes, and how this concern might lead some patients who would benefit from statin therapy to prevent cardiovascular events from taking a statin. Good news on this front from a recent Lancet article which further analyzes the data from the JUPITER trial that raised the concern in the first place.
The benefits of statin therapy in preventing heart attacks and cardiovascular death in patients at high risk for cardiovascular disease, especially those who have previously had a coronary event or those with diabetes is well established. Diabetes itself is a major risk factor for cardiovascular disease. The concern that taking a statin might itself lead to diabetes is disconcerting. Good news is upon us though with the further analysis provided in this Lancet article. Here are the highlights:
- The authors conclude: “In the JUPITER primary prevention trial, the cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard, including in participants at high risk of developing diabetes.”
- Specifically for patients with one or more major risk factors for diabetes, “a total of 134 vascular events or deaths were avoided for every 54 new cases of diabetes diagnosed.”
- For patients with no major risk factors for diabetes: “a total of 86 vascular events or deaths were avoided with no new cases of diabetes diagnosed.”
- The four factors considered major diabetes risk factors for the purposes of this analysis were: Metabolic Syndrome, Impaired Glucose Tolerance, BMI >30 and HbA1C >6.0%
- The primary cardiovascular end points in the JUPITER study were myocardial infarction, hospital admission for unstable angina, arterial revascularization, and cardiovascular death.
Admittedly these diabetes risk factors are very common. Especially the BMI >30 risk factor. Per CDC statistics in 2009 9 U.S. states has >30% or adults with a BMI>30, and another 24 had an average BMI between 25-29%. The second tier includes Washington where I practice. It’s good to know that even in this large number of patients at increased risk of diabetes treatment with a statin has a net positive effect when used in patients with elevated LDL cholesterol.