medwireNews: Study findings published in JAMA Internal Medicine show that treatment initiation with statins is associated with an elevated risk for diabetes progression.
In their analysis of the US Department of Veterans Affairs (VA) database, Ishak Mansi, from the VA North Texas Health System in Dallas, USA, and fellow investigators observed that individuals initiating statins between 2003 and 2015 were significantly more likely to experience diabetes progression than those initiating an active comparator (H2 blockers or proton pump inhibitors), at an odds ratio (OR) of 1.37.
They found that after an average treatment duration of 5.3 years, 55.9% of the 83,022 statin users and 48.0% of the same number of propensity score-matched individuals receiving an active comparator experienced the composite outcome of diabetes progression, defined as therapy intensification or new persistent hyperglycemia or acute glycemic complications. The number needed to be exposed to statins for one additional person to experience diabetes progression was 13.
Mansi et al also report that “[e]ach individual component of the composite outcome was significantly higher among statin users” versus nonusers, at ORs of 1.41 for increase in the number of glucose-lowering medication classes, 1.16 for new insulin initiation, 1.13 for persistent hyperglycemia, and 1.24 for a new diagnosis of ketoacidosis or uncontrolled diabetes.
The odds for diabetes progression among statin users versus nonusers were higher for people without comorbidities compared with those in the overall cohort, at ORs of 1.56 and 1.40, respectively.
Moreover, a dose-response association was observed between the intensity of low-density lipoprotein (LDL) cholesterol lowering and risk diabetes progression. The OR for diabetes progression among statin users compared with nonusers was 1.83 for high-intensity cholesterol lowering (≥50% reduction in mean LDL cholesterol from baseline), compared with 1.55 and 1.45 for moderate (30 to <50%) and low-intensity (<30%) cholesterol lowering, respectively.
The team notes that although the higher risk for diabetes progression associated with statin use may seem less consequential than the cardiovascular benefits of statin use, “diabetes progression has long-term effects on quality of life and treatment burden, which warrant consideration when discussing the overall risk-benefit profile, especially when used for primary prevention.”
They conclude: “Further research is needed to form a risk-tailored approach to balancing the cardiovascular benefits of statin therapy with its risk of diabetes progression.”
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