Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet Diabetes & Endocrinology, 12(5), 306–319. https://doi.org/10.1016/S2213-8587(24)00040-8 Cholesterol Treatment Trialists’ (CTT) Collaboration
Points
- Statin therapy was found to cause a moderate dose-dependent increase in new diagnoses of diabetes, with a majority of new cases occurring in individuals with baseline glycaemic markers close to the diagnostic threshold for diabetes.
- Allocation to low-intensity or moderate-intensity statin therapy resulted in a 10% proportional increase in new-onset diabetes, while high-intensity statin therapy led to a 36% proportional increase.
- The extent of HbA1c measurement was identified as the primary determinant of the magnitude of the absolute excesses in the two types of trials rather than the proportional increase in risk associated with statin therapy.
- The relative effects of statin therapy on new-onset diabetes were consistent among different types of participants and over time.
- The study emphasized that any theoretical adverse effects of statins on cardiovascular risk arising from small increases in glycemia are already accounted for in the overall reduction in cardiovascular risk seen with statin therapy in these trials.
Summary
The study aimed to address the gaps in knowledge regarding the size and timing of the effect of statin therapy on the risk of diabetes and identify the individuals at the most significant risk. The researchers conducted a meta-analysis of individual participant data from large, long-term, randomized, double-anonymized trials of statin therapy. The analysis included 19 trials comparing statin versus placebo (123,940 participants, 25,701 with diabetes) and four trials comparing more versus less intensive statin therapy (30,724 participants, 5,340 with diabetes). The median follow-up duration was 4.3 years for the former and 4.9 years for the latter.
The findings revealed that allocation to low-intensity or moderate-intensity statin therapy resulted in a 10% proportional increase in new-onset diabetes. In comparison, high-intensity statin therapy resulted in a 36% proportional increase. The study also highlighted that the primary determinant of the magnitude of the absolute excesses in the two types of trials was the extent of HbA1c measurement rather than the proportional increase in risk associated with statin therapy. Additionally, the relative effects of statin therapy on new-onset diabetes were similar among different types of participants and over time. Among participants with baseline diabetes, the relative risks for worsening glycemia were 1.10 for low-intensity or moderate-intensity statin therapy and 1.24 for high-intensity statin therapy compared with placebo.
In conclusion, the study demonstrated that statins cause a moderate dose-dependent increase in new diagnoses of diabetes, consistent with a slight upwards shift in glycemia, with the majority of new diagnoses occurring in people with baseline glycaemic markers close to the diagnostic threshold for diabetes. Notably, the study emphasized that any theoretical adverse effects of statins on cardiovascular risk arising from these small increases in glycemia are already accounted for in the overall reduction in cardiovascular risk seen with statin therapy in these trials. These findings provide valuable insights for informing clinical guidelines regarding managing individuals taking statin therapy.
Link to the article: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00040-8/fulltext
References Reith, C., Preiss, D., Blackwell, L., Emberson, J., Spata, E., Davies, K., Halls, H., Harper, C., Holland, L., Wilson, K., Roddick, A. J., Cannon, C. P., Clarke, R., Colhoun, H. M., Durrington, P. N., Goto, S., Hitman, G. A., Hovingh, G. K., Jukema, J. W., … Zannad, F. (2024). Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: An individual participant data meta-analysis. The Lancet Diabetes & Endocrinology, 12(5), 306–319. https://doi.org/10.1016/S2213-8587(24)00040-8
