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Atorvastatin therapy: cardiovascular event reduction versus new-onset diabetes


The purpose of the study was to compare the incidence of new-onset diabetes ( NOD ) with cardiovascular event reduction at different levels of NOD risk.

Statins reduce the number of cardiovascular events but increase the incidence of new-onset diabetes. Four factors independently predicted new-onset diabetes: fasting blood glucose greater than 100 mg/dl, fasting triglycerides greater than 150 mg/dl, body mass index greater than 30 kg/m2, and history of hypertension.

Researchers have compared new-onset diabetes incidence with cardiovascular event reduction among 15,056 patients with coronary disease but without diabetes at baseline in the TNT ( Treating to New Targets ) ( n = 7,595 ) and IDEAL ( Incremental Decrease in Endpoints Through Aggressive Lipid Lowering ) ( n = 7,461 ) trials.
Cardiovascular events included coronary heart disease death, myocardial infarction, stroke, and resuscitated cardiac arrest.

Among 8,825 patients with 0 to 1 of the aforementioned new-onset diabetes risk factors at baseline, diabetes mellitus developed in 142 of 4,407 patients in the Atorvastatin ( Lipitor ) 80 mg group and in 148 of 4,418 in the Atorvastatin 10 mg and Simvastatin ( Zocor ) 20 to 40 mg groups ( 3.22% vs 3.35%; hazard ratio, HR=0.97 ).

Among the remaining 6,231 patients with 2 to 4 new-onset diabetes risk factors, diabetes mellitus developed in 448 of 3,128 in the Atorvastatin 80 mg group and in 368 of 3,103 in the lower-dose groups ( 14.3% vs 11.9%; HR=1.24; p = 0.0027 ).

The number of cardiovascular events was significantly reduced with Atorvastatin 80 mg in both new-onset diabetes risk groups.

In conclusion, compared with lower-dose statin therapy, Atorvastatin 80 mg/day did not increase the incidence of new-onset diabetes in patients with 0 to 1 NOD risk factors but did, by 24%, among patients with 2 to 4 NOD risk factors.
The number of cardiovascular events was significantly reduced with Atorvastatin 80 mg in both NOD risk groups. ( Xagena )

Waters DD et al, J Am Coll Cardiol 2013;61:148-152

XagenaMedicine_2013



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