(22-10-12) New JUPITER Analysis Clarifies Risk for Incident Diabetes with Statin Therapy

Benefits probably outweigh harms, even in patients with diabetes risk factors.
Several trials and meta-analyses have suggested that statin use raises risk for diabetes. In the industry-funded JUPITER trial (JW Gen Med Nov 18 2008), more than 17,000 patients without previous cardiovascular disease or diabetes and with LDL cholesterol levels <130 mg/dL and high-sensitivity C-reactive protein levels 2.0 mg/L were randomized to receive either daily rosuvastatin (Crestor; 20 mg) or placebo. By 2 years, rosuvastatin recipients had experienced 44% fewer adverse cardiovascular events but were 25% more likely to have received incide nt diabetes diagnoses.
The JUPITER investigators now report the influence of baseline diabetes risk factors (metabolic syndrome, impaired fasting glucose, body-mass index 30 kg/m2, or glycosylated hemoglobin [HbA1c] >6%) on incident diabetes. Among 11,508 patients with at least one baseline diabetes risk factor, 61 fewer rosuvastatin recipients than placebo recipients reached the primary cardiovascular endpoint, 32 fewer suffered venous thromboembolisms or noncardiac-related deaths, and 54 more received new diagnoses of diabetes. Among 6095 patients with no diabetes risk factors, rosuvastatin recipients were no more likely than placebo recipients to have received new diabetes diagnoses.
Comment: Controversy continues about the risks and benefits of statins in patients at low cardiac risk. This study suggests that the effect of statins on diabetes consists largely of accelerated diabetes development in patients who are already at risk and is outweighed by prevention of vascular events.

Source: ? Bruce Soloway, MD
Published in Journal Watch General Medicine September 6, 2012

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