Highlights
- •Trial meta-analyses showed an increased risk of statin-associated diabetes of 9–13%.
- •Our meta-analysis of observational studies showed an increased risk of 44%.
- •Our results confirm the need of a rigorous monitoring of patients taking statins.
Abstract
Background and aims
Meta-analyses of randomized control trials investigating the association between incident
diabetes and statin use showed an increased risk of new-onset diabetes (NOD) from
9% to 13% associated with statins. However, short follow-up period, unpowered sample
size, and lack of pre-specified diagnostic criteria for diabetes detection could be
responsible of an underestimation of this risk. We conducted a meta-analysis of published
observational studies to evaluate the association between statins use and risk of
NOD.
Methods and results
PubMed, EMBASE and MEDLINE databases were searched from inception to June 30, 2016
for cohort and case–control studies with risk of NOD in users vs nonusers, on ≥1000
subjects followed-up for ≥1 year. Two review authors assessed study eligibility and
risk of bias and undertook data extraction independently. Pooled estimates were calculated
by a random-effects model and between-study heterogeneity was tested and measured
by I2 index. Furthermore, stratified analyses and the evaluation of publication bias were
performed. Finally, the meta-analysis included 20 studies, 18 cohort and 2 case–control
studies. Overall, NOD risk was higher in statin users than nonusers (RR 1.44; 95%
CI 1.31–1.58). High between-study heterogeneity (I2 = 97%) was found. Estimates for all single statins showed a class effect, from rosuvastatin
(RR 1.61; 1.30–1.98) to simvastatin (RR 1.38; 1.19–1.61).
Conclusions
The present meta-analysis confirms and reinforces the evidence of a diabetogenic effect
by statins utilization. These observations confirm the need of a rigorous monitoring
of patients taking statins, in particular pre-diabetic patients or patients presenting
with established risk factors for diabetes.
Keywords
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Article info
Publication history
Published online: March 10, 2017
Accepted:
March 2,
2017
Received in revised form:
January 11,
2017
Received:
November 8,
2016
Identification
Copyright
© 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.
