ONLY USE DRUGS WHEN THERE ARE CLEAR INDICATIONS. ONE OF THE PROBLEM WITH STATINS.

GONG XI FA CAI to one and all. I am back from my golfing.

The just published online edition of the Lancet, carried a very interesting study by the workers from Glasgow University. The paper by Dr Sattar N, Preiss D, Murray HM, et al. is entitled " Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; DOI:10.1016/S0140-6736(09)61965-6". It is available at http://www.lancet.com. This is another of those electronic trials and online research of previous megatrails and also their meta-analysis of the results. Their aim was to see if there is any truth in the suspicion, made more obvious by the JUPITER trial, that the use of statins may be associated with a higher incidence of diabetes. We first saw this trend in the earlier statin trials but it was less pronounced. Dr Sattar and colleagues, researched 13 statin trials done in the nineties and two thousands, any witha followup of more then 1 year and with an enrollment of more then 1,000 patients. It had to be placebo controlled and they stidied those who were none diabtics at the start of the trial. What they found was that at an average of 4 years of followup, there was a 9% higher incidence of diabetes amongst those taking statins. The risk seemed to be higher the more potent the statins. In the Jupiter trial, the incidence of new onset diabetes was 18% higher at a mean follow-up of only 1.9 years. The risk was lowest with pravastatin. In fact the earlier WESCOP study did not show any increase in incidence of T2DM. To put it in perspective. the authors worked out that over 4 years follow-up, for every 255 patients treated with statins, you will see 1 case of new onset diabetes, and you will save 5.4 cases of MIs or death from heart disease. Meaning that on the balance, it is still worthwhile to use statins in secondary prevention of CAD. Well statins for primary prevention, that maybe a different story. I personally will not use statins liberally in pprimary prevention, unless that patient is at high risk and has failed life-style modification. When we use drugs without clear indication, we never know what awaits to haunt us later. This is a good example. In the nineties, we have no clue that statins maybe associated with new onset diabetes. We will not be doing our patients any favours by exchanging just a raise LDL-C level with a 9% chance of getting T2DM in the next 4 years. It may wiser to institute life style modification and discuss the risk of statins, before simply starting statins for just a raise LDL-C. We all learn, or dont we?