Cardiovascular Event Reduction Versus New-Onset Diabetes During Atorvastatin Therapy

Objectives The purpose of this study was to compare the incidence of new-onset diabetes (NOD) with cardiovascular (CV) event reduction at different levels of NOD risk. Background Statins reduce the number of CV events but increase the incidence of NOD. We previously reported that 4 factors independe...

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Published in:Journal of the American College of Cardiology 2013-01, Vol.61 (2), p.148-152
Main Authors: Waters, David D., MD, Ho, Jennifer E., MD, Boekholdt, S. Matthijs, MD, PhD, DeMicco, David A., DPharm, Kastelein, John J.P., MD, PhD, Messig, Michael, PhD, Breazna, Andrei, PhD, Pedersen, Terje R., MD, PhD
Format: Article
Language:English
Subjects:
atorvastatin
Blood pressure
Body mass index
Cardiology
Cardiovascular
Cardiovascular disease
cardiovascular events
Cholesterol
Confidence intervals
Diabetes
Drug therapy
Glucose
Heart attacks
Hypertension
Insulin resistance
Internal Medicine
Lipoproteins
Mortality
Risk factors
Statins
Stroke
Triglycerides
Variables
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Summary:Objectives The purpose of this study was to compare the incidence of new-onset diabetes (NOD) with cardiovascular (CV) event reduction at different levels of NOD risk. Background Statins reduce the number of CV events but increase the incidence of NOD. We previously reported that 4 factors independently predicted NOD: fasting blood glucose >100 mg/dl, fasting triglycerides >150 mg/dl, body mass index >30 kg/m2 , and history of hypertension. Methods We compared NOD incidence with CV event reduction among 15,056 patients with coronary disease but without diabetes at baseline in the TNT (Treating to New Targets) (n = 7,595) and IDEAL (Incremental Decrease in Endpoints Through Aggressive Lipid Lowering) (n = 7,461) trials. CV events included coronary heart disease death, myocardial infarction, stroke, and resuscitated cardiac arrest. Results Among 8,825 patients with 0 to 1 of the aforementioned NOD risk factors at baseline, NOD developed in 142 of 4,407 patients in the atorvastatin 80 mg group and in 148 of 4,418 in the atorvastatin 10 mg and simvastatin 20 to 40 mg groups (3.22% vs. 3.35%; hazard ratio [HR]: 0.97; 95% confidence intervals [CI]: 0.77 to 1.22). Among the remaining 6,231 patients with 2 to 4 NOD risk factors, NOD developed in 448 of 3,128 in the atorvastatin 80 mg group and in 368 of 3,103 in the lower-dose groups (14.3% vs. 11.9%; HR: 1.24; 95% CI: 1.08 to 1.42; p = 0.0027). The number of CV events was significantly reduced with atorvastatin 80 mg in both NOD risk groups. Conclusions Compared with lower-dose statin therapy, atorvastatin 80 mg/day did not increase the incidence of NOD in patients with 0 to 1 NOD risk factors but did, by 24%, among patients with 2 to 4 NOD risk factors. The number of CV events was significantly reduced with atorvastatin 80 mg in both NOD risk groups.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2012.09.042