Cardiovascular Event Reduction Versus New-Onset Diabetes During Atorvastatin Therapy

Division of Cardiology, San Francisco General Hospital and the University of California at San Francisco, San Francisco, California. Electronic address: .
Journal of the American College of Cardiology (Impact Factor: 16.5). 11/2012; 61(2). DOI: 10.1016/j.jacc.2012.09.042
Source: PubMed


OBJECTIVES: The purpose of this study was to compare the incidence of new-onset diabetes (NOD) with cardiovascular (CV) event reduction at different levels of NOD risk. BACKGROUND: Statins reduce the number of CV events but increase the incidence of NOD. We previously reported that 4 factors independently predicted NOD: fasting blood glucose >100 mg/dl, fasting triglycerides >150 mg/dl, body mass index >30 kg/m(2), and history of hypertension. METHODS: We compared NOD incidence with CV 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. CV events included coronary heart disease death, myocardial infarction, stroke, and resuscitated cardiac arrest. RESULTS: Among 8,825 patients with 0 to 1 of the aforementioned NOD risk factors at baseline, NOD developed in 142 of 4,407 patients in the atorvastatin 80 mg group and in 148 of 4,418 in the atorvastatin 10 mg and simvastatin 20 to 40 mg groups (3.22% vs. 3.35%; hazard ratio [HR]: 0.97; 95% confidence intervals [CI]: 0.77 to 1.22). Among the remaining 6,231 patients with 2 to 4 NOD risk factors, NOD 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; 95% CI: 1.08 to 1.42; p = 0.0027). The number of CV events was significantly reduced with atorvastatin 80 mg in both NOD risk groups. CONCLUSIONS: Compared with lower-dose statin therapy, atorvastatin 80 mg/day did not increase the incidence of NOD 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 CV events was significantly reduced with atorvastatin 80 mg in both NOD risk groups.

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Available from: David D Waters, Jun 28, 2015
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    • "Although it has been confirmed that the on-going diabetes plays a crucial part in inducing subsequent vascular dysfunction through affecting endothelium [3,12], the concerns regarding the priority (i.e. which comes first – vascular dysfunction or diabetes) was raised recently. The question was derived from the evidence that statin therapy increased the risk of new onset diabetes (NOD), of which belongs to T2DM, by 9% to 21% [13,14], and this was validated by a more recent study, in which if the patients had 2–4 risk factors for NOD, atorvastatin 80 mg increased the risk of NOD by 24% compared with standard therapy [15]. From these studies, at least in part, it can be deduced that vascular dysfunction itself could initiate diabetes even though the underlying mechanisms are not yet unknown. "
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    • "Atorvastatin was first introduced to clinical practice as a lipid-lowering agent and was thereafter found to have antioxidative and anti-inflammatory effects. Numerous clinical trials have consistently demonstrated the beneficial effects of atorvastatin on the prevention of cardiovascular disease and the improvement of outcomes in diabetic patients [11–14]. Several studies have shown that atorvastatin can improve estimated glomerular filtration rate, decrease serum creatinine (Cr), and exhibit beneficial effects on the renal function of diabetic patients [15, 16]. "
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    • "A recent study [26] compared the incidence of new-onset DM with CV risk reduction among 15,056 patients with coronary heart disease or a history of myocardial infarction but without DM at baseline in the TNT (Treating to New Targets) IDEAL (Incremental Decrease in Endpoints Through Aggressive Lipid Lowering) studies. Patients in these trials were randomly assigned to high- or low-dose statin (80 mg atorvastatin vs. 10 mg atorvastatin or 20–40 mg simvastatin). "
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