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
Authors' conclusion
Statins cause a moderate dose-dependent increase in new diagnoses of diabetes that is consistent with a small upwards shift in glycaemia, with the majority of new diagnoses of diabetes occurring in people with baseline glycaemic markers that are close to the diagnostic threshold for diabetes. Importantly, however, any theoretical adverse effects of statins on cardiovascular risk that might arise from these small increases in glycaemia (or, indeed, from any other mechanism) are already accounted for in the overall reduction in cardiovascular risk that is seen with statin therapy in these trials. These findings should further inform clinical guidelines regarding clinical management of people taking statin therapy.
Study context
- Population
- Double-blind statin RCTs of ≥2 years' scheduled duration and ≥1000 participants in the CTT Collaboration; 19 statin vs placebo trials (median follow-up 4.3 years) and 4 more vs less intensive trials (median follow-up 4.9 years)19 placebo-controlled + 4 intensity trials
- Comparison
- Statin therapy vs placebo; more vs less intensive statin therapy
- Outcome
- New-onset diabetes (diabetes-related adverse events, new glucose-lowering medications, glucose concentrations or HbA1c values)
Methodological detailsdouble-blind, prespecified protocol, inverse-variance-weighted, CTT Collaboration
- Double-blind
- Prespecified protocol
- Inverse-variance-weighted
- CTT Collaboration
Pooled result
As reported in the abstract
- New-onset diabetes cases already in top quarter of baseline glycaemia distribution
- ≈62%
Further pooled results
| Outcome | RR (CI) | |
|---|---|---|
| Worsening glycaemia in participants with baseline diabetesLow/moderate-intensity statinvs Placebo | 1.10 (1.06–1.14) | |
| Worsening glycaemia in participants with baseline diabetesHigh-intensity statinvs Placebo | 1.24 (1.06–1.44) | |
| 0.512Relative risk (log scale) |
Mean glucose increase in participants without baseline diabetes
mmol/L
- Low/moderate-intensity statin
- 0.04 (95% CI 0.03-0.05)
- High-intensity statin
- 0.04 (0.02-0.06)
Mean HbA1c increase in participants without baseline diabetes
- Low/moderate-intensity statin
- 0.06% (0.00-0.12)
- High-intensity statin
- 0.08% (0.07-0.09)
Original publication
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