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Context
Evidence suggests
that the health benefits of statin therapy may extend beyond its cholesterol-lowering
properties, potentially including favourable effects on systemic inflammation,
endothelial function and oxidative stress – important mechanisms involved in
the aetiology of cardiometabolic diseases. However, contrary to such a putative
benefit, meta-analyses of randomised trials have recently suggested that statin
use is associated with elevated diabetes risk compared with placebo.
Methods
The authors
identified statin trials using MEDLINE, EMBASE and the Cochrane Central
Register of Controlled Trials (January 1996 through March 2011). Inclusion criteria
for the trials included comparison of intensive-dose versus moderate-dose
statin therapy, sample size of at least 1000 participants and a mean follow up
of 1 year or more Incident diabetes was defined as an adverse event report of
newly diagnosed diabetes, new use of glucose-lowering medication or two fasting
plasma glucose (FPG) tests ≥126 mg/dl during the trial period.
Findings
During the mean follow-up of 4.9 years among a
total of 32 752 patients, 8.4% participants developed diabetes and 20.4%
patients experienced a CVD outcome. Compared with moderate-dose statin therapy,
the number needed to harm per year for intensive-dose statin therapy was
498 for new-onset diabetes, whereas the number needed to treat per year for
intensive-dose statin therapy was 155 for CVD.
Recommendation
Regular
screening for diabetes (among high-risk patients on statins) may be useful in
overall patient management, which should
also include lifestyle modification such as diet and exercise.
Reference
Swapnil N Rajpathak Commentary on: Preiss D,
Seshasai SR, Welsh P, et al. Risk of incident diabetes with
intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA
2011;305: 2556–64. In Evidence-Based Medicine April 2012 |
volume 17 | number 2 |
Excerpt from: Evidence Bases Medicine Journal
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