Friday, April 27, 2012

Risk-Benefit Analysis of Statins published in NEJM

There is still no understanding on the causal mechanism that leads to an increased risk of diabetes in patients taking statins, but for sure there seems to be a relation between the two, as meta-analysis is suggestive of strong correlation.
In the JUPITER study, which enrolled about 15,000 patients with elevated levels of CRP and low levels of LDL, showed that rosuvastatin was associated with  an increased risk of 25% in terms of patients diagnosed with newly onset diabetes.
A meta-analysis of about 5 stain trials ( approx 55,000 patients), shows a 13% increased risk of new onset diabetes with use of statins, while another meta-analysis of 13 statin trials involving approximately 91,000 patients found the odds of new onset diabetes as 9% with statins.
It was also revealed from the meta-analysis the effect is dose dependent.  The risk for new-onset diabetes is 12% higher with intensive-dose therapy than with moderate-dose therapy.  When the risk of new onset diabetes is viewed in conjunction with the benefit in CV risk reduction.  For every 1000 patient year, treatment with intensive dose reduces 6.5 CV Events at the cost of 2 case of new onset diabetes, comapared to treatment with moderate dose
 The authors acknowledge that in people with high cardiovascular risk, the net cardiovascular benefit “strongly favors statin use”. However, uncertainty remains on the use of statins for primary prevention in people with low cardiovascular risk.