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: dwaters@medsfgh.ucsf.edu

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

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