Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Statins and diabetes risk

The Lancet has published the results of a meta-analysis of randomised statin trials with the aim of establishing whether any association exists between statin use and development of diabetes. This analysis has been reported in the general media (BBC).

This analysis included data from 13 trials involving 91,140 participants. 4,278 participants developed diabetes during the trial periods (mean duration 4 years) with 2,226 assigned statins and 2,052 assigned control treatment.

Statin therapy was found to be associated with a statistically significant 9% increase in the risk of developing diabetes (odds ratio [OR] 1·09; 95% CI 1·02–1·17). The risk was found to be highest in older participants while baseline BMI and change in low-density lipoprotein-cholesterol (LDL-C) concentrations appear to be unimportant predictive factors.

Despite this finding the authors conclude that, "in view of the overwhelming benefit of statins for the reduction of cardiovascular events, the small absolute risk for development of diabetes is outweighed by cardiovascular benefit in the short and medium term". They recommend that current practice for statin therapy remains unchanged.

The authors also note that this analysis does not prove a causal relationship and that the observed difference may be due to residual confounding factors. They therefore also suggest that development of diabetes is included in future statin studies as a secondary outcome.

Action: Clinicians should be aware of these results and the associated media reports. Patients taking statins should be reassured that the benefits of therapy outweigh the risks. Screening for diabetes in patients taking statins, especially in older patients, may be a sensible strategy.

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