A meta-analysis suggests that patients who take high-dose statins have about 1% higher risk annually for newly diagnosed diabetes.

Statins are known to raise risk for diabetes modestly. In this meta-analysis of individual participant data from 23 randomised statin trials, researchers estimated the incidence of this adverse effect. Findings were as follows:

• the incidence of new-onset diabetes was only slightly (but statistically significantly) higher with low-to- moderate-intensity statins compared with placebo (1.3% vs 1.2% annually)
• in contrast to the small effect with low-to-moderate-intensity statin, risk for new-onset diabetes was more substantial with high-intensity statins compared with placebo (4.8% vs 3.5% annually).
• new-onset diabetes was diagnosed more often in patients with baseline glycated haemoglobin (HbA_1c) in the prediabetes range than in patients with lower HbA_1c
• in part, variability in incidence of diabetes across trials reflected how often HbA_1c was measured during follow up
• among patients with known diabetes at baseline, glycaemia worsened slightly with statin therapy compared with placebo.

Comment: Statins have a dose-dependent effect on glycaemia; in a small proportion of cases, that effect will result in a new diagnosis of diabetes. The authors conclude that any small increase in diabetes-related cardiovascular risk is ‘greatly outweighed’ by the overall risk-reducing benefit of statin therapy. That is certainly true for secondary prevention and for primary prevention in people at high risk. But it might not be true for primary prevention in patients with borderline indications for statin therapy.

An editorial by researchers from McMaster University in Canada provides a balanced perspective on these matters.

Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.

Cholesterol Treatment Trialists’ (CTT) Collaboration. Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis. Lancet Diabetes Endocrinol 2024; 12: 306-319.

Gerstein HC, Pigeyre M. How clinically relevant is statin-induced diabetes? Lancet Diabetes Endocrinol 2024; 12: 286-287.

This summary is taken from the following Journal Watch titles: General Medicine, Cardiology, Ambulatory Medicine, Hospital Medicine, Neurology.