Higher potency statins linked with diabetes risk

| June 2, 2014

Last week, my blog post focused on the issue of the adverse effects of statins, and in particular the way these can easily be hidden or missed in the context of studies known as randomised controlled trials. The blog post was triggered by some recent controversy in the British Medical Journal. Authors of two BMJ articles have withdrawn their claims about the incidence of adverse effects of statins, at the insistence of Professor Sir Rory Collins.

This week, the BMJ published another study that adds further to this debate [1]. It is well recognised that one potential adverse-effect of statins is the development of diabetes. In this new study, Canadian researchers pooled the results of several studies to see if the risk of diabetes was higher in individuals (with known cardiovascular disease) taking higher potency statins rather than lower ones. The researchers found that compared to lower potency statins, the taking of higher potency ones was associated with a 15 per cent increased risk of diabetes.

The evidence assessed in this study was epidemiological in nature, which means it shows that while the review found a link between higher dose statins and increased diabetes risk, this is just an association. However, we do know from other clinical studies, called randomised controlled trials (RCTs), that statins do have a genuine capacity to cause diabetes.

Perhaps in the ideal world we would be able to rely more heavily on RCTs to judge the safety of statins. However, a fundamental problem is that RCTs are often designed or reported in a way that can massively downplay any hazards or harms.

A case in point, is diabetes. Earlier this year saw the publication of a study which claimed that side-effects from statins were no more common than those seen in people taking placebo [2]. Within the discussion of this paper we find the following text: “…commercial sponsors of clinical trials may not be motivated to search exhaustively for potential side effects. One pointer towards this is that…new diagnosis of diabetes was only documented in three of the 29 trials.”

So, only in about 10 per cent of the trials assessed in this review was the development of diabetes even documented. Of course what this means is that we simply can’t rely on the RCTs to assess the diabetes risk that statins bring.

While the potential diabetes risk from statins is now established, the conventional response from those generally in favour of statin therapy has been that the benefits ‘massively outweigh’ the risks. Actually, the evidence on adverse effects is so corrupted and incomplete, this claim simply cannot be made with any certainty.

The authors of the study point out that while statins reduce risk of overall mortality in those with known cardiovascular disease (secondary prevention), higher potency statins do not work any better than lower ones here. Bearing this in mind, the authors suggest that doctors should consider the potential diabetes risk of prescribing high potency statins to patients in the secondary prevention setting.

Here's to a healthy heart

Dr John Briffa
Editor
for The Cholesterol Truth



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Bear in mind we are not addressing anyone’s personal situation and you should rely on this for informational purposes only. Please consult with your own physician before acting on any recommendations contained herein.


References:

1. Dormuth CR, et al. Higher potency statins and the risk of new diabetes: multicentre, observational study of administrative databases. BMJ 2014;348:g3244 (Published 29 May 2014)

2. Finegold JA, et al. What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice. European Journal of Preventive Cardiology 2014;21(4):464-74

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Category: Latest Statin Research

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