Friday, August 10, 2012


In the 11th August issue of lancet, Dr Paul Ridker, the principal investigator of JUPITER has written an article entitled "Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial". In this article, he agreed that there is an increase risk of developing diabetes in those taking Rosuvastatin. He and team however concluded that the risk of developing diabetes, is far outweighed by the benefits derived from statin protection and a primary preventive measure. I am not sure if that logic holds water. As physicians, we do not wish to give our patients new diseases in our effort to treat and help a potential one. Remember that JUPITER was over a slightly less than 2 year period. What if the followup had been over 5 years? will we see a doubling of diabetes? So now, we have used a drug to reduce CV events in people who are healthy. This drug, if taken over the long term gives us a disease that can increase our risk of CV events. Now, how will the equation balance out after 5-10 years? Interesting issue.
I believe that all statins have this problem. As had been done, a closer look at Women Health Initiative, PROVE-IT, TNT, IDEAL, A to Z, and SEARCH ( all statin trials ) showed the same. In fact, we now know that high dose statins increase the risk of Diabetes by about 12% ( 1 in 10 ). It looks like we can also identify, those likely to develop diabetes with statins, like the obesed, those with impaired GTT to start, those with pre-diabetes, and those with raised Hb A 1 c to start.
I must say that looking at the overall picture, it may be better to use statins in the secondary prevention of CAD than in the primary prevention. I cannot agree with the logic of giving a drug to a healthy person to reduce his chance of a CV event, while at the same time ( over many years, more years than clinical trial data is available ), giving them a 12% risk of a disease which could potentially give you more CV events, as well as a risk of renal, CNS, eye and peripheral vascular disease. After all, you have an alternative, called healthy lifestyle chances of diet, and exercise.
That is just my opinion.


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