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Cholesterol: slightly higher risk of type 2 diabetes with all statins

Several large-scale studies have revealed an increased risk of type 2 diabetes in patients taking a statin.

Statins are widely used to lower cholesterol, in the hope of reducing the risk of premature death and major cardiovascular events (myocardial infarction, ischaemic stroke).

A review has been carried out of 13 studies which included patient follow-up for at least one year. Some 91,000 non-diabetic participants were monitored for 4 years on average. During the trial, 4,278 became diabetic: 2,226 taking statins versus 2,052 in the control group. This difference is statistically significant: one additional case of diabetes occurs for approximately every 255 patients taking a statin for 4 years. The risk of diabetes developing during statin treatment was higher among elderly patients.

Two other meta-analyses respectively involving around 110,000 and 250,000 patients revealed similar findings, and the conclusion was the same in some ten epidemiological studies.

The risk of associated type 2 diabetes is dose-dependent and has been observed with all statins.

A statistically significant reduction in overall mortality became apparent following comparative trials with pravastatin and simvastatin in secondary prevention of cardiovascular disease. The risk of diabetes linked to statins does not call into question their preventive use in this setting. But the risk of diabetes is part of statins’ harm-benefit balance, and should be discussed and weighed up with patients when statin treatment is envisaged and when type 2 diabetes occurs under statins.

©Prescrire 1 January 2017

"Statins: increased risk of type 2 diabetes" Prescrire Int 2017; 26 (178): 18-19. (Pdf, subscribers only).

Download the full review.
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