Scale tips toward statin use for cardiovascular disease prevention

The benefits of statin therapy for cardiovascular disease (CVD) prevention appear to dwarf the associated risk of developing diabetes, as suggested in a study.

The analysis included 115,939 individuals aged >50 years who had recently initiated statin treatment and were residing in the Italian Lombardy Region. Researchers followed them for the incidence of macrovascular complication and at least one sign suggestive of new-onset diabetes.

Treatment adherence level was greater among men; patients using atorvastatin, rosuvastatin, and high-potency statins; those affected by some comorbidities; and those taking other drugs concomitantly.

During the follow-up, 14,652 individuals died, 10,562 had stroke, 5,762 had myocardial infarction, and 7,120 had heart failure. Meanwhile, 12,539 participants developed diabetes, with an incidence of 15 cases every 1,000 person-years.

Cox proportional hazard models showed that high vs very low adherence level with statins conferred a significant protection against macrovascular risk (28 percent, 95 percent confidence interval [CI], 23–33) but also an excess risk of incident diabetes (67 percent, 95 percent CI, 50–86).

In the entire population, the numbers of individuals who must be treated with statins in order to prevent a macrovascular complication (number needed to treat [NNT]) and to generate a new-onset diabetes (number needed to harm [NNH]) were 26 and 65, respectively. NNT was consistently lower than NNH in all considered strata of age, gender, and clinical profile.

The present data provide real-world evidence that the balance between the CV benefit and the diabetogenic harm of statin use is largely favourable to the treatment benefits, according to the researchers.