Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials
Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials
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DOI：
10.1016/s0140-6736(09)61965-6
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发表时间：
2010-02-27
期刊：
影响因子：
168.9
通讯作者：
Ford, Ian
中科院分区：
文献类型：
--
作者：
Sattar, Naveed;Preiss, David;Ford, Ian
背景 他汀类药物治疗试验对于接受他汀类药物治疗的患者患糖尿病的风险存在相互矛盾的结果。我们的目的是通过对已发表和未发表的数据进行荟萃分析，以确定他汀类药物的使用与糖尿病的发展之间是否存在任何关系。方法我们检索了 Medline、Embase 和 Cochrane 对照试验中央注册库。 1994年至2009年，他汀类药物的随机对照终点试验。我们仅纳入了超过 1000 名患者的试验，两组患者的随访情况相同，且持续时间超过 1 年。我们排除了器官移植或需要血液透析患者的试验。我们使用 12 项统计数据来衡量试验之间的异质性，并通过随机效应荟萃分析计算了糖尿病发生的风险估计。结果 我们确定了 13 项他汀类药物试验，共有 91140 名参与者，其中 4278 名（2226 名分配他汀类药物和 2052 名分配对照治疗）平均在 4 年内患上糖尿病。他汀类药物治疗与糖尿病发病风险增加 9% 相关（比值比 [OR] 1.09；95% CI 1.02-1.17），试验之间几乎没有异质性 (I-2=11%)。荟萃回归显示，在老年参与者的试验中，他汀类药物患糖尿病的风险最高，但基线体重指数和低密度脂蛋白胆固醇浓度的变化都不能解释风险的残余变化。 255 名 (95% CI 150-852) 患者接受他汀类药物治疗 4 年，结果增加了 1 例糖尿病。 解释 他汀类药物治疗与患糖尿病的风险略有增加有关，但无论从绝对值还是与冠状动脉事件的减少相比，该风险都很低。具有中度或高度心血管风险或现有心血管疾病的患者的临床实践不应改变。
Background Trials of statin therapy have had conflicting findings on the risk of development of diabetes mellitus in patients given statins. We aimed to establish by a meta-analysis of published and unpublished data whether any relation exists between statin use and development of diabetes.Methods We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from. 1994 to 2009, for randomised controlled endpoint trials of statins. We included only trials with more than 1000 patients, with identical follow-up in both groups and duration of more than 1 year. We excluded trials of patients with organ transplants or who needed haemodialysis. We used the 12 statistic to measure heterogeneity between trials and calculated risk estimates for incident diabetes with random-effect meta-analysis.Findings We identified 13 statin trials with 91140 participants, of whom 4278 (2226 assigned statins and 2052 assigned control treatment) developed diabetes during a mean of 4 years. Statin therapy was associated with a 9% increased risk for incident diabetes (odds ratio [OR] 1.09; 95% CI 1.02-1.17), with little heterogeneity (I-2=11%) between trials. Meta-regression showed that risk of development of diabetes with statins was highest in trials with older participants, but neither baseline body-mass index nor change in LDL-cholesterol concentrations accounted for residual variation in risk. Treatment of 255 (95% CI 150-852) patients with statins for 4 years resulted in one extra case of diabetes.Interpretation Statin therapy is associated with a slightly increased risk of development of diabetes, but the risk is low both in absolute terms and when compared with the reduction in coronary events. Clinical practice in patients with moderate or high cardiovascular risk or existing cardiovascular disease should not change.