https://orcid.org/0000-0002-4218-3066
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Daniela Pedicino, Massimo Volpe, Weekly Journal Scan: A reassuring answer to questions about statin therapy and diabetes, European Heart Journal, Volume 45, Issue 41, 1 November 2024, Pages 4449–4450, https://doi.org/10.1093/eurheartj/ehae486
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Comment on the article ‘Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis’ published in the The Lancet Diabetes & Endocrinology, https://doi.org/10.1016/S2213-8587(24)00040-8.
Comment
Diabetes represents a global pandemic, directly contributing to severe pathological conditions including kidney failure, blindness, myocardial infarction, stroke, lower limb amputation, and cognitive impairment. It is associated with excess cardiovascular risk, independently from other established risk factors, such as atherogenic lipid profile, smoking habits, and high blood pressure, with a two-fold increased risk of mortality.1,2 Large observational and Mendelian randomization studies have demonstrated that lower glucose levels along the lifetime correspond to a lower risk of adverse cardiovascular outcomes.3,4 Of note, also fasting plasma glucose or HbA1c levels falling in the spectrum of pre-diabetes have been associated with increased cardiovascular risk.5 This means that individuals with an early onset of diabetes or higher plasma glucose levels are those at highest risk, and, consequently, a detailed assessment of both the degree and duration of dysglycaemia is of paramount importance in understanding the overall impact on cardiovascular risk.6 In this regard, the use of drugs that increase plasma glucose concentrations and possibly augment the risk of developing diabetes should be carefully evaluated to balance benefits and risks for the patients. Statins represent a first-line therapy to reduce cardiovascular events in those with and without diabetes who have high cardiovascular risk or established cardiovascular disease. Previous studies suggested that statin treatment is associated with a slightly higher risk of new-onset diabetes, as reflected by small increases in blood glucose.7 These data could be at least partly supported by the association between a genetically determined low LDL cholesterol concentration and a higher risk of diabetes.8 However, the precise mechanisms underlying this association (including individuals at higher risk or the effects of different statin regimens) could not be derived from the available evidence.
