StatinStatins and s and DiabetDiabeteses

betweenbetween risks and benefitsrisks and benefits

Alexandru AndritoiuAlexandru AndritoiuMilMiliitary Hospital tary Hospital Craiova, MD, Craiova, MD,

MPhMPh

Drugs that induce diabetesDrugs that induce diabetes

Drugs that cause diabetes by interfering with insulin production and secretionDrugs that cause diabetes by interfering with insulin production and secretion VacorVacor TacrolimusTacrolimus DidansoineDidansoine β-receptor antagonistsβ-receptor antagonists L-asparaginaseL-asparaginase DiphenylhydantoinDiphenylhydantoin DiazoxideDiazoxide Drugs that cause diabetes by reducing the effectiveness of insulin to regulate metabolismDrugs that cause diabetes by reducing the effectiveness of insulin to regulate metabolism SteroidsSteroids GlucocorticoidsGlucocorticoids Megasterol acetateMegasterol acetate β-receptor agonistsβ-receptor agonists Growth hormoneGrowth hormone Protease inhibitorsProtease inhibitors Drugs that act on both insulin secretion and insulin sensitivityDrugs that act on both insulin secretion and insulin sensitivity Thiazide diureticsThiazide diuretics CyclosporineCyclosporine Atypical antipsychotic medicationsAtypical antipsychotic medications Treatments that induce diabetes by increasing nutrient fluxTreatments that induce diabetes by increasing nutrient flux Nicotinic acidNicotinic acid Total parenteral nutritionTotal parenteral nutrition

Richard J Coli D. Diabetes Melitus: A Fundamental and Clinical Text. 3rd Edition 2004

Routine monitoring of Routine monitoring of liver enzymesliver enzymes in the blood, once considered in the blood, once considered standard procedure for statin users, is no longer needed. Such standard procedure for statin users, is no longer needed. Such monitoring has not been found to be effective in predicting or monitoring has not been found to be effective in predicting or preventing the rare occurrences of serious liver injury associated preventing the rare occurrences of serious liver injury associated with statin use.with statin use.

Cognitive (brain-related) impairmentCognitive (brain-related) impairment, such as memory loss, , such as memory loss, forgetfulness and confusion, has been reported by some statin forgetfulness and confusion, has been reported by some statin users.users.

People being treated with statins may have an increased risk of People being treated with statins may have an increased risk of raised blood sugar levels and the development of Type 2 raised blood sugar levels and the development of Type 2 diabetes.diabetes.

Some medications interact with lovastatin (brand names include Some medications interact with lovastatin (brand names include Mevacor) and can increase the risk of muscle damage.Mevacor) and can increase the risk of muscle damage.

FDA Expands Advice on Statin Risks (2012)

FDA Adds Diabetes, Memory Loss Warnings to FDA Adds Diabetes, Memory Loss Warnings to StatinsStatins  ReutersReuters

Safety Alerts Cite Cholesterol Drugs’ Side Safety Alerts Cite Cholesterol Drugs’ Side Effects Effects The New YorkThe New York TimesTimes

Statin Labels will Come with New Safety Statin Labels will Come with New Safety WarningsWarnings CNNCNN

FDA Adds Safety Warnings to Statins FDA Adds Safety Warnings to Statins HealthDayHealthDay FDA Adds Diabetes Warning to Statin FDA Adds Diabetes Warning to Statin

LabelLabel  MedPage TodayMedPage Today

To prescribe or not to prescribe: To prescribe or not to prescribe: That is the statin questionThat is the statin question

Blumenthal RS. Redberg R. Should healthy people take cholesterol drugs to prevent heart disease? Wall Street Journal, January 23, 2012.

The Diabetes Dilemma for Statin UsersThe Diabetes Dilemma for Statin Users

ERIC J. TOPOLERIC J. TOPOL Published: March 4, 2012Published: March 4, 2012

,,,,We need to find out why statins cause diabetes and, ideally, We need to find out why statins cause diabetes and, ideally, through through genomicsgenomics we could determine who is at risk for this we could determine who is at risk for this important side effect. important side effect.

But to date nothing has been done to sort this out — despite But to date nothing has been done to sort this out — despite the fact that the market for statins is well over $20 billion per the fact that the market for statins is well over $20 billion per year. year.

TThere are thousands of blood samples sitting in company here are thousands of blood samples sitting in company freezers around the world that could potentially provide the freezers around the world that could potentially provide the answersanswers””

The LancetThe Lancet, Volume 380, Issue 9841, , Volume 380, Issue 9841, Pages 565 - 571, 11 August 2012Pages 565 - 571, 11 August 2012

Cardiovascular benefits and diabetes Cardiovascular benefits and diabetes risks of statin therapy in primary risks of statin therapy in primary prevention: an analysis from the prevention: an analysis from the

JUPITER trialJUPITER trial

Paul M Ridker, Paul M Ridker, et alet al

In the JUPITER primary prevention trial, In the JUPITER primary prevention trial, the cardiovascular and mortality benefits the cardiovascular and mortality benefits of statin therapy exceed the diabetes of statin therapy exceed the diabetes hazard, including in participants at high hazard, including in participants at high risk of developing diabetes.risk of developing diabetes.

Diabetes CareDiabetes Care  October 2009;October 2009; vol. 32vol. 32:: no.10 no.10:: 1924-1929 1924-1929

Statin Therapy and Risk of Developing Statin Therapy and Risk of Developing Type 2 Diabetes: A Meta-AnalysisType 2 Diabetes: A Meta-Analysis

SwapnilSwapnil N. N. RajpathakRajpathak, , DharamDharam J. J. KumbhaniKumbhani, , Jill CrandallJill Crandall, ,

NirNir BarzilaiBarzilai,,  Michael Alderman, Paul M. Ridker.Michael Alderman, Paul M. Ridker.

RESULTS  In the meta-analysis of the hypothesis-testing trials,

we observed a small increase in diabetes risk (RR 1.13 [95% CI 1.03–1.23])

Meta-analysis of clinical trials evaluating the effects of statins on diabetes riskMeta-analysis of clinical trials evaluating the effects of statins on diabetes risk

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

A Meta-analysis A Meta-analysis  David PreissDavid Preiss, Sreenivasa Rao Kondapally Seshasai, , Sreenivasa Rao Kondapally Seshasai,

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

June 22; 2011, Vol 305, No. 2

INTERPRETATION:INTERPRETATION: Statin therapy is associated with a slightly Statin therapy is associated with a slightly

increased risk of development of diabetes, but increased risk of development of diabetes, but the risk is low both in absolute terms and when the risk is low both in absolute terms and when compared with the reduction in coronary events.compared with the reduction in coronary events.

Clinical practice in patients with moderate or Clinical practice in patients with moderate or high cardiovascular risk or existing high cardiovascular risk or existing cardiovascular disease should not change.cardiovascular disease should not change.

ResultsResults    In 5 statin trials with In 5 statin trials with 3232..752 participants752 participants without diabetes at without diabetes at

baseline, 2749 developed diabetes (1449 assigned intensive-dose baseline, 2749 developed diabetes (1449 assigned intensive-dose therapy, 1300 assigned moderate-dose therapy, representing 2.0 therapy, 1300 assigned moderate-dose therapy, representing 2.0 additional cases in the intensive-dose group per 1000 patient-additional cases in the intensive-dose group per 1000 patient-years) and 6684 experienced cardiovascular events (3134 and years) and 6684 experienced cardiovascular events (3134 and 3550, respectively, representing 6.5 fewer cases in the intensive-3550, respectively, representing 6.5 fewer cases in the intensive-dose group per 1000 patient-years) over a weighted mean (SD) dose group per 1000 patient-years) over a weighted mean (SD) follow-up of 4.9 (1.9) years. follow-up of 4.9 (1.9) years.

Odds ratios were 1.12 (95% confidence interval [CI], 1.04-Odds ratios were 1.12 (95% confidence interval [CI], 1.04-1.22; 1.22; II2 = 0%) for new-onset diabetes and 0.84 (95% CI, 0.75-2 = 0%) for new-onset diabetes and 0.84 (95% CI, 0.75-0.94; 0.94; II2 = 74%) for cardiovascular events for participants receiving 2 = 74%) for cardiovascular events for participants receiving intensive therapy compared with moderate-dose therapy.intensive therapy compared with moderate-dose therapy.

As compared with moderate-dose statin therapy, the number As compared with moderate-dose statin therapy, the number needed to harm per year for intensive-dose statin therapy was 498 needed to harm per year for intensive-dose statin therapy was 498 for new-onset diabetes while the number needed to treat per year for new-onset diabetes while the number needed to treat per year for intensive-dose statin therapy was 155 for cardiovascular events.for intensive-dose statin therapy was 155 for cardiovascular events.

Conclusion:  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.

Date of download: 9/23/2012Copyright © 2012 American Medical

Association. All rights reserved.

From: Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy: A Meta-analysis

JAMA. 2011;305(24):2556-2564. doi:10.1001/jama.2011.860

Data marker size indicates relative weight of the studies; OR, odds ratio; and CI, confidence interval.

Figure Legend:

Date of download: 9/23/2012Copyright © 2012 American Medical

Association. All rights reserved.

From: Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy: A Meta-analysis

JAMA. 2011;305(24):2556-2564. doi:10.1001/jama.2011.860

Data were available for age, high-density lipoprotein (HDL) cholesterol levels, and triglyceride concentrations in all trials; for body mass index (BMI) in 4 trials; and for fasting plasma glucose levels in 3 trials. The medians of the variables are per-trial medians, which are provided in the eTable. P values apply to heterogeneity between groups. Data marker size indicates relative weight of the studies; OR, odds ratio; and CI, confidence interval.

Figure Legend:

Statins and risk of incident diabetes: Statins and risk of incident diabetes:

a collaborative meta-analysis of a collaborative meta-analysis of randomised statin trialsrandomised statin trials

Sattar N et al.- Sattar N et al.- Lancet 2010Lancet 2010;;27;375:735-27;375:735-7742 42

13 statin trials13 statin trials 9191..140 participants, of whom 4278 (2226 assigned statins and 2052 140 participants, of whom 4278 (2226 assigned statins and 2052

assigned control treatment) developed diabetes during a mean of 4 years.assigned control treatment) developed diabetes during a mean of 4 years. Statin therapy was associated with a 9% increased risk for incident diabetesStatin therapy was associated with a 9% increased risk for incident diabetes

(odds ratio [OR] 1·09; 95% CI 1·02—1·17), with little heterogeneity (odds ratio [OR] 1·09; 95% CI 1·02—1·17), with little heterogeneity (I2=11%) between trials. (I2=11%) between trials.

Meta-regression showed that risk of development of diabetes with statins Meta-regression showed that risk of development of diabetes with statins was highest in trials with older participants, but neither baseline body-was highest in trials with older participants, but neither baseline body-mass index nor change in LDL-cholesterol concentrations accounted for mass index nor change in LDL-cholesterol concentrations accounted for residual variation in risk. residual variation in risk.

Treatment of 255Treatment of 255 (95% CI 150—852) (95% CI 150—852) patients with statins for 4 years patients with statins for 4 years resulted in one extra case of diabetesresulted in one extra case of diabetes..

InterpretationInterpretation Statin therapy is associated with a slightly increased risk of development Statin therapy is associated with a slightly increased risk of development

of diabetesof diabetes, but the risk is low both in absolute terms and when compared , but the risk is low both in absolute terms and when compared with the reduction in coronary events. with the reduction in coronary events.

Clinical practice in patients with moderate or high cardiovascular Clinical practice in patients with moderate or high cardiovascular risk or existing cardiovascular disease should not change.risk or existing cardiovascular disease should not change.

Sattar N et al. Lancet 2010

Statin Use and Risk of Diabetes Statin Use and Risk of Diabetes Mellitus in Postmenopausal WomenMellitus in Postmenopausal Women

Annie L. Culver, Annie L. Culver, et al. - et al. - Arch Intern Med.Arch Intern Med.  

Published online January 9, 2012 Published online January 9, 2012

Study links statins to higher diabetes in Study links statins to higher diabetes in older womenolder women

Culver AL, Ockene IS, Balasubramanian R Culver AL, Ockene IS, Balasubramanian R

Statin use and risk of diabetes mellitus in Statin use and risk of diabetes mellitus in postmenopausal women in the Women's postmenopausal women in the Women's

Health Initiative. Health Initiative.

Arch Intern Med 2012;Arch Intern Med 2012;

Results Results    This investigation included 153 840 This investigation included 153 840

women without DM and no missing women without DM and no missing data at baseline. At baseline, 7.04% data at baseline. At baseline, 7.04% reported taking statin medication. reported taking statin medication.

There were 10 242 incident cases of There were 10 242 incident cases of self-reported DM over 1 004 466 self-reported DM over 1 004 466 person-years of follow-up.person-years of follow-up.

Statin use at baseline was associated Statin use at baseline was associated with an increased risk of DM (hazard with an increased risk of DM (hazard ratio [HR], 1.71; 95% CI, 1.61-1.83). ratio [HR], 1.71; 95% CI, 1.61-1.83).

This association remained after This association remained after adjusting for other potential adjusting for other potential confounders (multivariate-adjusted confounders (multivariate-adjusted HR, 1.48; 95% CI, 1.38-1.59) and was HR, 1.48; 95% CI, 1.38-1.59) and was observed for all types of statin observed for all types of statin medications. medications.

Subset analyses evaluating the Subset analyses evaluating the association of self-reported DM with association of self-reported DM with longitudinal measures of statin use in longitudinal measures of statin use in 125 575 women confirmed these 125 575 women confirmed these findings.findings.

Conclusions Conclusions    Statin medication use in Statin medication use in

postmenopausal women is postmenopausal women is associated with an increased associated with an increased risk for DM. risk for DM.

This may be a medication This may be a medication class effect.class effect.

Further study by statin type Further study by statin type and dose may reveal varying and dose may reveal varying risk levels for new-onset DM in risk levels for new-onset DM in this population.this population.

Arch Intern Med. Published online January 9, 2012

Statins raise risk of Type 2 diabetes in older Statins raise risk of Type 2 diabetes in older womenwomen

Post-menopausal women who take statins to ward off heart attacks are more likely to develop Type 2 diabetes than those who do not, research indicates.

January 10, 2012 By Melissa Healy, Los Angeles Times

Diabetes/statin link probed in EFFECT cohortDiabetes/statin link probed in EFFECT cohort

World Congress of Cardiology 2012World Congress of Cardiology 2012

Dr Altayyeb Yousef  (Institute for Clinical Evaluative Sciences, Toronto)

,,The message for the public is that statins have documented benefits over many years. The risk of developing diabetes with a statin vs placebo is probably there, but when we talk about dose relationships, we can't find any evidence of a difference between doses,"

END POINTSEND POINTS deaths, deaths or ACS, or new-onset diabetes in deaths, deaths or ACS, or new-onset diabetes in

the EFFECT study cohort—all patients who had the EFFECT study cohort—all patients who had been hospitalized for acute MI. been hospitalized for acute MI.

CONCLUSIONSCONCLUSIONS Comparing results among 2870 matched Comparing results among 2870 matched

patients, they found no significant differences in patients, they found no significant differences in any of those three end points out to five years. any of those three end points out to five years.

At each year out to five years, the risk of At each year out to five years, the risk of diabetes was actually lower, numerically, among diabetes was actually lower, numerically, among the intensive-statin group as compared with the the intensive-statin group as compared with the moderate-dose group, although differences were moderate-dose group, although differences were not statistically significant.not statistically significant.

Rautio N, Jokelainen J, Oksa H, et al.Rautio N, Jokelainen J, Oksa H, et al.

BMJBMJ 2012 2012

Do statins interfere with lifestyle intervention Do statins interfere with lifestyle intervention in the prevention of diabetes in primary in the prevention of diabetes in primary healthcare? One-year follow-up of the healthcare? One-year follow-up of the

FIN-D2D project FIN-D2D project 

TThis is the first study examining the association of lifestyle his is the first study examining the association of lifestyle intervention on the risk of type 2 diabetes according to the use of intervention on the risk of type 2 diabetes according to the use of statins. This question is of utmost clinical importance, since we now statins. This question is of utmost clinical importance, since we now know that type 2 diabetes is preventable by lifestyle changes.know that type 2 diabetes is preventable by lifestyle changes.

Fasting glucose increased by 0.08 mmol/L in statin usersFasting glucose increased by 0.08 mmol/L in statin users but but remained unchanged in nonusers. This was a significant difference remained unchanged in nonusers. This was a significant difference and remained so after adjustment for age, sex, baseline fasting and remained so after adjustment for age, sex, baseline fasting glucose, presence of CVD, use of antihypertensive and/or CAD glucose, presence of CVD, use of antihypertensive and/or CAD medication, weight, and one-year weight change.medication, weight, and one-year weight change.

An increase in fasting glucose in statin users suggests An increase in fasting glucose in statin users suggests deterioration deterioration in insulin secretion capacity,in insulin secretion capacity, but added that two-hour glucose but added that two-hour glucose values, which reflect insulin sensitivity, were similarly decreased in values, which reflect insulin sensitivity, were similarly decreased in statin users and nonusers.statin users and nonusers.

"The message for clinicians is that patients who "The message for clinicians is that patients who have multiple components of the metabolic have multiple components of the metabolic syndrome need to try to further improve their syndrome need to try to further improve their lifestyle habits to combat the possible rise in lifestyle habits to combat the possible rise in glucose when a statin is begun. This paper glucose when a statin is begun. This paper suggests that statins may have unfavorable suggests that statins may have unfavorable effects on glucose metabolism in certain people, effects on glucose metabolism in certain people, so compliance with lifestyle improvements will so compliance with lifestyle improvements will be very important. We look forward to more be very important. We look forward to more prospective studies on this topic."prospective studies on this topic."

Dr Nina Rautio -BMJ ; September 13, 2012

Statins, Risk of Diabetes, and Statins, Risk of Diabetes, and Implications on Outcomes in the Implications on Outcomes in the

General Population General Population

Kang-Ling Wang, et al. Kang-Ling Wang, et al.

J Am Coll CardiolJ Am Coll Cardiol. 2012;60(14):1231-1238 . 2012;60(14):1231-1238

ObjectivesObjectives

This study aimed to evaluate the This study aimed to evaluate the association of statin exposure and incident association of statin exposure and incident diabetes, and subsequent outcomes in the diabetes, and subsequent outcomes in the general population.general population.

Kang-Ling Wang, et al. - J Am Coll Cardiol. 2012;60(14):1231-1238.

ResultsResults

Over a median of 7.2 years, annual rates of Over a median of 7.2 years, annual rates of diabetes were significantly higher in statin diabetes were significantly higher in statin

usersusers

(2.4% vs. 2.1%; p < 0.001)(2.4% vs. 2.1%; p < 0.001)

MACEMACE

HR: 0.82; CI 0.68-0.98 for myocardial infarctionHR: 0.82; CI 0.68-0.98 for myocardial infarction

HR: 0.94; CI 0.86-1.03 for ischemic strokeHR: 0.94; CI 0.86-1.03 for ischemic stroke

HR: 0.91; CI:0.84-0.99 for MACEHR: 0.91; CI:0.84-0.99 for MACE

In-hospital mortality In-hospital mortality

HR: 0.61; CI:0.55-0.67 HR: 0.61; CI:0.55-0.67

Kang-Ling Wang, et al. - J Am Coll Cardiol. 2012;60(14):1231-1238.

The risk–benefit analysesThe risk–benefit analyses

Statin treatment was favorable in high-risk and Statin treatment was favorable in high-risk and secondary prevention populations. secondary prevention populations.

Among diabetic patients, prior statin use was Among diabetic patients, prior statin use was associated with fewer MACEassociated with fewer MACE

In-hospital deaths were similar in statin-related In-hospital deaths were similar in statin-related diabetes among high-risk and secondary diabetes among high-risk and secondary prevention subjects compared with nondiabetic prevention subjects compared with nondiabetic controls.controls.

Conclusions Risk of diabetes was increased after statins,

but outcomes were favorable.

Kang-Ling Wang, et al. - J Am Coll Cardiol. 2012;60(14):1231-1238

Kaplan-Meier Curves for Outcomes Among Statin and Control Groups

(A) Cumulative incidences for newly developed diabetes in the statin and control groups were 22.7% and 20.8%, respectively.

(B) Cumulative incidences for major adverse cardiovascular (CV) events (the composite of myocardial infarction [MI] and ischemic stroke) in the statin and control groups were 11.6% and 12.6%,

(C)Cumulative incidences for in-hospital death from all causes in the statin and control groups were 8.8% and 13.8%.

Kang-Ling Wang, et al. - J Am Coll Cardiol. 2012;60(14):1231-1238.

Predictors of New-Onset Diabetes in Predictors of New-Onset Diabetes in Patients Treated with AtorvastatinPatients Treated with Atorvastatin

Results From 3 Large Randomized Clinical TrialsResults From 3 Large Randomized Clinical Trials

David D. WatersDavid D. Waters, Jennifer E. Ho, David A. , Jennifer E. Ho, David A. DeMicco, Andrei Breazna,Benoit J. DeMicco, Andrei Breazna,Benoit J. Arsenault, Chuan-Chuan Wun, John J. Arsenault, Chuan-Chuan Wun, John J. Kastelein, Helen Colhoun, Philip Barter Kastelein, Helen Colhoun, Philip Barter

J Am Coll CardiolJ Am Coll Cardiol. 2011;57(14):1535-1545. 2011;57(14):1535-1545

Predictors of New-Onset Diabetes in Patients Treated With Atorvastatin: Results From 3 Large Randomized Clinical Trials

J Am Coll Cardiol. 2011;57(14):1535-1545

Incident Diabetes According to Incident Diabetes According to Number of Risk FactorsNumber of Risk Factors

IIncident diabetes in (A) the TNT trial, (B) the ncident diabetes in (A) the TNT trial, (B) the IDEAL trial, and (C) the SPARCL trial IDEAL trial, and (C) the SPARCL trial according to number of risk factors and according to number of risk factors and treatment group. treatment group. AAtorva. = atorvastatin; ATV10 = atorvastatin 10 torva. = atorvastatin; ATV10 = atorvastatin 10 mg; ATV80 = atorvastatin 80 mg; Simva = mg; ATV80 = atorvastatin 80 mg; Simva = simvastatin;simvastatin;

J Am Coll Cardiol 2011;57(14):1535-1545

ConclusionsConclusions  

High-dose atorvastatin treatment High-dose atorvastatin treatment (80mg/day) (80mg/day) compared with placebo in the compared with placebo in the SPARCL trial is associated with a slightly SPARCL trial is associated with a slightly increased risk of new-onset T2DM. increased risk of new-onset T2DM.

Baseline fasting glucose level and features Baseline fasting glucose level and features of the metabolic syndrome are predictive of the metabolic syndrome are predictive of new-onset T2DM across the 3 trials.of new-onset T2DM across the 3 trials.

Waters DD et al. J Am Coll Cardiol. 2011;57(14):1535-1545

How effective are statins for How effective are statins for people with diabetes?people with diabetes?

Almost three-fifths of people Almost three-fifths of people with diabetes do not meet their with diabetes do not meet their cholesterol targets cholesterol targets

An analysis by Diabetes UK found that An analysis by Diabetes UK found that more than nine out of ten (91.6 per cent) more than nine out of ten (91.6 per cent) people with diabetes in England now people with diabetes in England now receive an annual check.receive an annual check.

Yet almost 60 per cent of patients are Yet almost 60 per cent of patients are still not meeting their targets, the still not meeting their targets, the research revealed.research revealed.

Most people with diabetes Most people with diabetes 'have poor cholesterol control''have poor cholesterol control'

How effective are statins for people with diabetes?How effective are statins for people with diabetes?

Collaborative Atorvastatin Diabetes Collaborative Atorvastatin Diabetes Study (CARDS)Study (CARDS)

This study involved nearly 3000 people This study involved nearly 3000 people with Type 2 diabetes aged 40-75.with Type 2 diabetes aged 40-75.

It looked at the benefits of taking a 10mg It looked at the benefits of taking a 10mg dose of atorvastatin daily.dose of atorvastatin daily.

None of the participants had heart disease None of the participants had heart disease at the start of the trial, but they did at the start of the trial, but they did have an extra risk factor for developing have an extra risk factor for developing it, such as smoking, high blood it, such as smoking, high blood pressure, diabetic retinopathy or pressure, diabetic retinopathy or protein in the urine indicating diabetic protein in the urine indicating diabetic kidney disease.kidney disease.

For those taking the statin, the risk of heart For those taking the statin, the risk of heart attack reduced by 37 per cent and attack reduced by 37 per cent and stroke by 48 per cent.stroke by 48 per cent.

These benefits were seen regardless of These benefits were seen regardless of age, sex or whether the cholesterol age, sex or whether the cholesterol level was high or low.level was high or low.

The trial's success meant it was halted two The trial's success meant it was halted two years early.years early.

The Heart Protection Study (HPS)The Heart Protection Study (HPS)The HPS study involved nearly 6000 The HPS study involved nearly 6000

people with diabetes aged 40-80.people with diabetes aged 40-80.It looked at the benefits of taking a 40mg It looked at the benefits of taking a 40mg

dose of simvastatin each day. Just dose of simvastatin each day. Just under half of the participants showed under half of the participants showed signs of cardiovascular disease, while signs of cardiovascular disease, while half did not.half did not.

It found this routine use of statins cut the It found this routine use of statins cut the number of heart attacks and strokes in number of heart attacks and strokes in both groups by a thirdboth groups by a third..

CONCLUSIONSCONCLUSIONS

High-Dose Statins May Increase High-Dose Statins May Increase Diabetes RiskDiabetes Risk

but,but,

Experts Say Most Heart Disease Patients Are Better Off Taking a Statin,

Despite Increased Diabetes Risk