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Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials

医学 内科学 他汀类 糖尿病 优势比 荟萃分析 临床试验 随机对照试验 临床终点 2型糖尿病 相对风险 置信区间 内分泌学
作者
Naveed Sattar,David Preiss,Heather Murray,Paul Welsh,Brendan M. Buckley,Anton JM de Craen,Sreenivasa Rao Kondapally Seshasai,John J.V. McMurray,Dilys J. Freeman,J. Wouter Jukema,Peter W. Macfarlane,Chris J. Packard,David J. Stott,Rudi G. J. Westendorp,James Shepherd,Barry R. Davis,Sara Pressel,Roberto Marchioli,Rosa Maria Marfisi,Aldo P. Maggioni
出处
期刊:The Lancet [Elsevier BV]
卷期号:375 (9716): 735-742 被引量:2283
标识
DOI:10.1016/s0140-6736(09)61965-6
摘要

Trials of statin therapy have had conflicting findings on the risk of development of diabetes mellitus in patients given statins. We aimed to establish by a meta-analysis of published and unpublished data whether any relation exists between statin use and development of diabetes.We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1994 to 2009, for randomised controlled endpoint trials of statins. We included only trials with more than 1000 patients, with identical follow-up in both groups and duration of more than 1 year. We excluded trials of patients with organ transplants or who needed haemodialysis. We used the I(2) statistic to measure heterogeneity between trials and calculated risk estimates for incident diabetes with random-effect meta-analysis.We identified 13 statin trials with 91 140 participants, of whom 4278 (2226 assigned statins and 2052 assigned control treatment) developed diabetes during a mean of 4 years. Statin therapy was associated with a 9% increased risk for incident diabetes (odds ratio [OR] 1.09; 95% CI 1.02-1.17), with little heterogeneity (I(2)=11%) between trials. Meta-regression showed that risk of development of diabetes with statins was highest in trials with older participants, but neither baseline body-mass index nor change in LDL-cholesterol concentrations accounted for residual variation in risk. Treatment of 255 (95% CI 150-852) patients with statins for 4 years resulted in one extra case of diabetes.Statin therapy is associated with a slightly increased risk of development of diabetes, but the risk is low both in absolute terms and when compared with the reduction in coronary events. Clinical practice in patients with moderate or high cardiovascular risk or existing cardiovascular disease should not change.None.
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