Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy

Preiss, David; Seshasai, Sreenivasa Rao Kondapally; Welsh, Paul; Murphy, Sabina A.; Ho, Jennifer E.; Waters, David D.; DeMicco, David A.; Barter, Philip J.; Cannon, Christopher P.; Sabatine, Marc S.; Braunwald, Eugene; Kastelein, John J.P.; Lemos, James A. de; Blazing, Michael A.; Pedersen, Terje R.; Tikkanen, Matti J.; Sattar, Naveed; Ray, Kausik K.

doi:10.1001/jama.2011.860

Cited by 1,246 publications

(936 citation statements)

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“…Assumptions reflect arbitrary estimates of how informed clinicians would balance recommendations and benefit:risk information. For every 2 additional cases of incident diabetes mellitus with high‐ versus moderate‐intensity statin in patients with CHD, 6.5 fewer major vascular events occur 16. Dr Robinson, co‐author of the 2013 Cholesterol Guideline, summarized safety data on statin therapy,14, 27, 28 which indicated that the 5‐year number needed‐to‐harm (NNH) was ≈167 for moderate‐intensity and 63 for high‐intensity statin therapy 19.…”

Section: Methodsmentioning

confidence: 99%

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Egan

White

et al. 2016

JAHA

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BackgroundHealthy People 2020 aim to reduce fatal atherosclerotic cardiovascular disease (ASCVD) by 20%, which translates into 310 000 fewer events annually assuming proportional reduction in fatal and nonfatal ASCVD. We estimated preventable ASCVD events by implementing the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Cholesterol Guideline in all statin‐eligible adults. Absolute risk reduction (ARR) and number needed‐to‐treat (NNT) were calculated.Methods and ResultsNational Health and Nutrition Examination Survey data for 2007–2012 were analyzed for adults aged 21 to 79 years and extrapolated to the US population. Literature‐guided assumptions were used including (1) low‐density lipoprotein cholesterol falls 33% with moderate‐intensity statins and 51% with high‐intensity statins; (2) for each 39 mg/dL decline in low‐density lipoprotein cholesterol, 10‐year ASCVD 10 risk would fall 21% when ASCVD 10 risk was ≥20% and 33% when ASCVD 10 risk was <20%; and (3) either all statin‐eligible untreated adults or all with ASCVD 10 risk ≥7.5% would receive statins. Of 175.9 million adults aged 21 to 79 years not taking statins, 44.8 million (25.5%) were statin eligible. Treating all statin‐eligible adults would prevent an estimated 243 589 ASCVD events annually (ARR 5.4%, 10‐year NNT 18). Treating all statin‐eligible adults with ASCVD 10 risk ≥7.5% reduces the number treated to 32.2 million (28.2% fewer), whereas ASCVD events prevented annually fall only 10.5% to 217 974 (6.8% ARR, NNT 15).ConclusionsImplementing the ACC/AHA 2013 Cholesterol Guideline in all untreated, statin‐eligible adults could achieve ≈78% of the Healthy People 2020 ASCVD prevention goal. Most of the benefit is attained by individuals with 10‐year ASCVD risk ≥7.5%.

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Section: Methodsmentioning

confidence: 99%

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Egan

White

et al. 2016

JAHA

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“…In subsequent meta-analyses of the available results from the randomized trials, standard statin dose regimens were associated with a proportional increase of about 10% in reported diabetes, and more intensive statin regimens (as used in JUPITER) with about a 10% further increase. 48,225 This excess of diabetes diagnoses appeared soon after the statin therapy started, chiefly among patients who had risk factors for diabetes (e.g. elevated BMI or HbA1c, or impaired fasting glucose), and did not appear to get larger as treatment continued.…”

Section: Increases In Rates Of Diabetes Mellitusmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms SummaryThis review is intended to help clinicians, patients and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomized controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment.Large-scale randomized trial evidence shows that statin therapy reduces the risk of heart attacks, ischaemic strokes and coronary revascularization procedures ("major vascular events") by about one quarter for each mmol/L reduction in low density lipoprotein (LDL) cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (e.g. atorvastatin 40 mg daily, costing about £2 per

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“…Also, because the cohort was followed up for a median of 3.3 years, the generalization of results to the long‐term effects of non‐HDL on the development of diabetes was limited. Third, data from statin trials showed that statin therapy might increase the risk of new‐onset diabetes 29. Although we excluded individuals who used statins at enrollment, we could not account for the use of statins during follow up because of the lack of interim data.…”

Section: Discussionmentioning

confidence: 99%

Non‐high‐density lipoprotein cholesterol is more informative than traditional cholesterol indices in predicting diabetes risk for women with normal glucose tolerance

Liu

Qiu

Yuan

et al. 2018

J of Diabetes Invest

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Aims/IntroductionLimited data are available regarding the performance of non‐high‐density lipoprotein cholesterol (non‐HDL) in predicting incident diabetes. We aimed to analyze the association between non‐HDL and development of diabetes, and to estimate the cut‐off point of non‐HDL for discriminating incident diabetes in people with normal glucose tolerance.Materials and MethodsOf 3,653 middle‐aged and elderly Chinese with normal glucose tolerance at enrollment, 1,025 men and 1,805 women returned to the 3‐year follow up and were involved in the final analysis. Logistic regression analysis was used to test the association between cholesterol indices and incident diabetes, and receiver operating characteristic analyses were used to identify the optimal cut‐off of each cholesterol variable for incident diabetes.ResultsNon‐HDL was an independent risk factor for diabetes for women, but not for men. In women, a 1‐standard deviation increment in non‐HDL was associated with a 1.43‐fold higher risk of diabetes (95% confidence interval 1.14–1.79; P = 0.002), whereas odds ratios for total cholesterol and low‐density lipoprotein cholesterol were 1.33 (95% confidence interval 1.06–1.67; P = 0.015) and 1.30 (95% confidence interval 1.04–1.64; P = 0.024), respectively. The discriminatory power and the optimal cut‐off value of non‐HDL for incident diabetes increased across body mass index categories. For women with obesity, the threshold of non‐HDL for screening of diabetes was estimated as 3.51 mmol/L.ConclusionsNon‐HDL had better performance than traditional cholesterol indices in predicting diabetes in women, but not in men. A body mass index‐specific threshold value for a non‐HDL‐controlling target is required in the prevention of type 2 diabetes.

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Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy

Abstract: In a pooled analysis of data from 5 statin trials, intensive-dose statin therapy was associated with an increased risk of new-onset diabetes compared with moderate-dose statin therapy.

Cited by 1,246 publications

References 32 publications

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Interpretation of the evidence for the efficacy and safety of statin therapy

Non‐high‐density lipoprotein cholesterol is more informative than traditional cholesterol indices in predicting diabetes risk for women with normal glucose tolerance

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