Pharmacotherapy: Implications of high-dose statin link with incident diabetes.

摘要

The results of a meta-analysis indicate that high-dose statin therapy is associated with improved cardiovascular outcomes, but also a 12% increased risk of new-onset diabetes mellitus, compared with moderate-dose statin therapy. These findings have instigated much debate about how best to treat patients who are not reaching target non-HDL-cholesterol levels on moderate doses of statins.The meta-analysis by David Preiss and colleagues included data from a total of 32,752 patients without diabetes at baseline, gathered from five clinical trials of statins: the A to Z (Aggrasat to Zocor) trial, the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial, the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction) trial, SEARCH (Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine), and the TNT (Treating to New Targets) trial. Both atorvastatin 80 mg and simvastatin 80 mg were associated with similar risks of new-onset diabetes, but they reduced the risk of cardiovascular events by 22% and 5%, respectively, compared with placebo.