Meta-Analysis of Impact of Different Types and Doses of Statins on New-Onset Diabetes Mellitus
Meta-Analysis of Impact of Different Types and Doses of Statins on New-Onset Diabetes Mellitus
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DOI：
10.1016/j.amjcard.2012.12.037
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发表时间：
2013-04-15
影响因子：
2.8
通讯作者：
Kubica, Jacek
中科院分区：
文献类型：
--
作者：
Navarese, Eliano Pio;Buffon, Antonino;Kubica, Jacek
最近的报告表明，与安慰剂相比，他汀类药物与新发糖尿病（DM）风险增加相关，并且这种关系具有剂量依赖性。本研究的目的是对不同类型和剂量的他汀类药物对新发DM的影响进行随机对照试验（RCT）的综合网络荟萃分析。使用MEDLINE、Embase和科克伦数据库检索比较不同类型和剂量的他汀类药物与安慰剂的RCT。由2名独立研究者使用MEDLINE、科克伦、Google Scholar和Embase数据库以及主要心血管会议的摘要和报告，检索了1994年11月至2012年10月期间与本荟萃分析相关的RCT。确定了17项报告他汀类药物治疗期间新发DM发生率的RCT，共纳入113，394例患者。随机对照试验比较了他汀类药物与安慰剂或高剂量与中等剂量他汀类药物治疗。在不同的他汀类药物中，与安慰剂相比，普伐他汀40 mg/天与新发DM的最低风险相关（比值比1.07，95%可信区间0.86至1.30）。相反，与安慰剂相比，瑞舒伐他汀20 mg/天在数值上与DM风险增加25%相关（比值比1.25，95%可信区间0.82 - 1.90）。与安慰剂相比，阿托伐他汀80 mg/天对DM的影响似乎居中（比值比1.15，95%可信区间0.90 - 1.50）。这些发现在中等剂量下重复。总之，不同类型和剂量的他汀类药物显示出不同的增加DM发病率的潜力。(C)2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111：1123-1130）
Recent reports indicate that statins are associated with an increased risk for new-onset diabetes mellitus (DM) compared with placebo and that this relation is dose dependent. The aim of this study was to perform a comprehensive network meta-analysis of randomized controlled trials (RCTs) investigating the impact of different types and doses of statins on new-onset DM. RCTs comparing different types and doses of statins with placebo were searched for using the MEDLINE, Embase, and Cochrane databases. A search of RCTs pertinent to this meta-analysis covering the period from November 1994 to October 2012 was conducted by 2 independent investigators using the MEDLINE, Cochrane, Google Scholar, and Embase databases as well as abstracts and presentations from major cardiovascular meetings. Seventeen RCTs reporting the incidence of new-onset DM during statin treatment and including a total of 113,394 patients were identified. The RCTs compared either a statin versus placebo or high-dose versus moderate-dose statin therapy. Among different statins, pravastatin 40 mg/day was associated with the lowest risk for new-onset DM compared with placebo (odds ratio 1.07, 95% credible interval 0.86 to 1.30). Conversely, rosuvastatin 20 mg/day was numerically associated with 25% increased risk for DM compared with placebo (odds ratio 1.25, 95% credible interval 0.82 to 1.90). The impact on DM appeared to be intermediate with atorvastatin 80 mg/day compared with placebo (odds ratio 1.15, 95% credible interval 0.90 to 1.50). These findings were replicated at moderate doses. In conclusion, different types and doses of statins show different potential to increase the incidence of DM. (C) 2013 Elsevier Inc. All rights reserved. (Am J Cardiol 2013;111:1123-1130)