High dose atorvastatin associated with type 2 DM onset

January 01, 0001

High dose atorvastatin associated with type 2 DM onset

Statin therapy might modestly increase the risk of new-onset type 2 diabetes mellitus (T2DM). The researchers from the USA, The Netherlands and Australia sought to examine the incidence and clinical predictors of new-onset T2DM within 3 large randomized trials with atorvastatin. They used a standard definition of diabetes and excluded patients with prevalent diabetes at baseline. They identified baseline predictors of new-onset T2DM and compared the event rates in patients with and without new-onset T2DM.

In the TNT (Treating to New Targets) trial, 9.24% of patients randomized to 80 mg of atorvastatin and 8.11% of patients randomized to 10 mg developed new-onset T2DM (not significant). In the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial 6.40% of patients randomized to atorvastatin 80 mg/day and 5.59% of patients randomized to simvastatin 20 mg/day developed new-onset T2DM (not significant). In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, new-onset T2DM developed in 8.71% of patients randomized to atorvastatin 80 mg/day and in 6.06% of patients in the placebo group (significant). In each of the 3 trials, baseline fasting blood glucose, body mass index, hypertension, and fasting triglycerides were independent predictors of new-onset T2DM. Across the 3 trials, major cardiovascular events occurred in 11.3% of patients with and 10.8% of patients without new-onset T2DM (not significant).

The researchers concluded: "High-dose atorvastatin treatment compared with placebo in the SPARCL trial is associated with a slightly increased risk of new-onset T2DM. Baseline fasting glucose level and features of the metabolic syndrome are predictive of new-onset T2DM across the 3 trials."

Association doesn't prove causation.


For the full abstract, click here.

J Am Coll Cardiol 57:1535-1545, 5 April 2011 © 2011 by the American College of Cardiology Foundation
Predictors of New-Onset Diabetes in Patients Treated With Atorvastatin: Results From 3 Large Randomized Clinical Trials. David D. Water, Jennifer E. Ho, David A. DeMicco et al. Correspondence to David Water: [email protected]

Category: K. Circulatory. Keywords: diabetes, low-density lipoprotein (LDL) cholesterol, statin, randomized clinical trials, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 12 April 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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