Friday, April 01, 2011


The April 5th ( coming ) issue of the Journal of the American College of Cardiology, carries an interesting article by Dr David Waters of San Francisco Heart Hospital, studying the association ( if any ) between atorvastatin and new onset diabetes. He was just re-confirming what Dr Naveed Sattar had documented last year when he publishes in the Lancet ( Feb 17th 2010 ), the association of new onset diabetes with statins. Dr Naveed of University of Glasgow, had done a meta-analysis of 13 mega trials of statins, and found that the use of statins was associated with a 9% increase of new onset diabetes.
Dr Waters wanted to re-confirm that, but his meta-analysis only contains 3 trials, all with the use of atorvastatin ( a powerful, lipophilic statin ). Dr waters found that the use of atorvastatin was associated with a 2% increase in new onset diabetes. Dr Waters group was able to conclude that the risk of new onset diabetes with statins, was particularly in patients who were obese, had higher initial fasting blood sugar, had increase fasting triglycerides, and hypertension. But these are also exactly the factors which promote new onset diabetes, on its own. So it does become quite difficult to separate the statin effect from these other diabetogenic effects.
Both studies documented well that statins save more lives and reduces heart attacks, much much more than increase the risk of new onset diabetes. Both papers emphasized that although their findings were interesting and gave much food for thought, it should not deter anyone from using statins as secondary prevention, and in some patients, even primary prevention.
The authors calculated that using statins in 255 patients over 4 years will cause 1 case of new onset diabetes, and save 5.4 lives or heart attacks, thus justifying that statins will continue to be used for secondary prevention.
This effect of risk of new onset diabetes, was seen with all statins, whether they be hydrophilic ones ( pravastatin, rosuvastatin ), or lipophilic ones ( atorvastatin, simvastatin ). The other fact that also came out from these two trials, was that the more powerful, or the higher the dose, the more diabetogenic. Most of these risk of new onset diabetes, was associated with high dose atorvastatin ( 80 mg ), and also rosuvastatin.
Interesting. We should still continue to use statins because it saves lives, but we are also aware that there is a small chance of new onset diabetes. Perhaps keeping the dose reasonable, would be a good idea. "The lower the better" does have added new onset diabetic risk.

And no, this is not an April Fools joke.

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