Does intensive cholesterol lowering increase the risk of diabetes?
Abstract
To the Editor: The increase in the incidence of physicianreported diabetes noted in Justification of the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) may be seen as a ‘black hole’ in the ‘galaxy’ of statin-related cardiovascular benefits (1). The issue of statin effect on the risk of diabetes was raised by earlier studies (2–4). The pravastatinassociated decrease by 30% in the incidence of diabetes in the West of Scotland Coronary Prevention Study (WOSCOPS) led to expectations that statins may serve as effective agents in the prevention of diabetes (2). However, later large-scale randomised placebo-controlled clinical trials demonstrated no beneficial effect of pravastatin or other statins on diabetes risk (3–5). To date, there are many controversies with regard to the effect of statin treatment on outcomes in relation to the glycaemic control. Our recent study showed that short-term (12-week) rosuvastatin treatment adversely affected glucose homoeostasis by increasing insulin resistance (assessed by HOmeostasis Model Assessment (HOMA-IR) index) as well as fasting plasma insulin levels in a small cohort of dyslipidaemic patients with impaired fasting glucose (6). Commenting our work, Mascitelli and colleagues suggested that the cholesterollowering capacity of statins may comprise a determinant of the effect of statins on the risk of diabetes, implying that aggressive cholesterol treatment may increase the risk of diabetes (7).…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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