New Study on Statins and Developing Diabetes, Does it Impact Recommendations?

December 20, 2019

Diabetes Risk and Statins

An observational study was published in the American Journal of Cardiology was recently published looking at the risk of diabetes in patients with cardiovascular (CV) risk factors and taking statins:

Study Design

This study is great as it utilized the Kaiser Permanente database which includes patient information for > 4 million people.  For this study, they evaluated the impact of statins on the risk of diabetes risk in people with either:

  • LDL-C > 4.9 mmol/L (> 190 mg/dL)
  • LDL-C between 1.81mmol/L and 4.9 mmol/L (70-189 mg/dL) and an estimated 10-year CVD risk of ≥ 7.5%

This study included 28,149 patients who started on statin therapy as well as 28,149 patients who were also at risk but not started on lipid lowering therapy.  In matched patients, those who did or did not initiate statin therapy were similar in terms of age, gender, race/ethnicity, smoking status, educational attainment, and household income at entry.

Key Results

  • The average age of the two groups was 67.9 years
  • The unadjusted annual rate of incident diabetes mellitus was low 0.55 per 100 person-years (95% confidence interval 0.52-0.59)
    • The risk was higher in people taking statins (0.69 per 100 person-years [95%CI 0.64-0.75]) versus the control group (0.42 per 100-person years [95%CI 0.38-0.49])
  • Although there was a relative 17% increase in diabetes risk in people taking statin therapy, the absolute risk is low

What does this Mean for Practice?

  • This relationship between statins and diabetes risk has been previously published, but some of the data was conflicting
  • This is the largest real-world study demonstrating the small increase in absolute risk
  • My concern is that some people may hear about this study and stop their statin
  • The Diabetes Canada Guidelines looked at this increase in risk and stated:
    • “Accordingly, these recent analyses do not affect the recommendation that statins are the preferred agents for lowering LDL-C in most instances, including in people with established diabetes or in those with risk factors for developing the disease”
  • For your patients taking statins, the absolute benefits of these therapies likely greatly exceed the small increase in type 2 diabetes