High Potency Statins Associated with Developing Diabetes

New study shows that patients treated with atorvastatin had a 22% increase in the risk new-onset of diabetes….

Statins are among the most commonly prescribed medications in North America used to treat hyperlipidemia as well as prevent cardiovascular complications among other individuals.

Emerging evidence may suggest the use of the more potent statins may come with an increased risk of developing diabetes in individuals with no prior medical history of the disease.

Aleesa A. Carter, PharmD and her colleagues conducted a population based cohort study out of Ontario, Canada on patients aged 66 or older without diabetes who started treatment with statins from August 1, 1997 to March 31, 2010. The objective was to determine the risk of new onset diabetes among patients treated with different statins. The researchers’ primary outcome was incident diabetes, defined as a diagnosis of diabetes in the Ontario Diabetes Database. Patients and pertinent information was gathered from the Ontario Drug Benefit database, the Canadian Institute for Health Information Discharge Abstract Database, Ontario Diabetes Database, the Ontario Health Insurance Plan and the Ontario Registered Persons Database.

Over the course of the study, 471,250 patients were identified with no history of diabetes who initiated treatment with a statin. The previous study, West of Scotland coronary prevention study (WOSCOPS), found a 30% lower risk of diabetes in patients taking pravastatin compared to placebo. Carter et al. used patients treated with pravastatin as the reference comparison group for the analysis of their data due to this potential beneficial effect. The median age of the study population was 73 years old with 54.1 % of the patients female. Atorvastatin accounted for most of the prescribed statins, followed by rosuvastatin, simvastatin, pravastatin, lovastatin, and fluvastatin.

Carter and colleagues summarized their results by stating, "We found that patients treated with atorvastatin, rosuvastatin, or simvastatin were at increased risk of new onset diabetes compared with those treated with pravastatin. No such risk was evident with fluvastatin or lovastatin."

The study found, in comparison to patients treated with pravastatin, treatment with atorvastatin was associated with a 22% increase in the risk of new-onset diabetes. Rosuvastatin was associated with an 18% increased risk and simvastatin a 10% increased risk. No significant association of risk was found with the use of lovastatin or fluvastatin. However after covariate adjustment regarding the dose, rosuvastatin was associated with a non-significant increase in risk.

The results of this study are reported to be consistent with previous studies looking at the risk of new-onset diabetes with statin use. A meta- analysis conducted in 2009 found a 13% increased risk of diabetes in people taking statins compared with placebo. However Carter et al. note that a limitation to their study was the inability to account for weight, ethnicity, and family history as potential risk factors for diabetes. Another variable unaccounted for is the common practice to use newer, more potent statins in patients who are already at risk for developing diabetes.

The researchers concluded, "Our findings suggest that older patients treated with certain statins are at increased risk for incident diabetes, regardless of dose or whether treatment is used for primary or secondary prevention… Clinicians should consider this risk when they are contemplating statin treatment for individual patients."

A. A. Carter, T. Gomes, X. Camacho, D. N. Juurlink, B. R. Shah, M. M. Mamdani. Risk of incident diabetes among patients treated with statins: population based study.BMJ, 2013; 346 (may23 4): f2610 DOI: 10.1136/bmj.f2610