CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

August 9th, 2012

Reports from JUPITER and Taiwan: Benefits of Statins Outweigh Risk for Diabetes

Two new papers provide further evidence that statin use is associated with an increased risk for diabetes, but both studies also find that the benefits of statins still outweigh the risks.

In one report, published in the Lancet, Paul Ridker and colleagues analyze data from the JUPITER trial, which compared rosuvastatin to placebo in a primary-prevention population.

Among the 17,603 patients randomized in the trial, 11,508 had at least one major risk factor for developing diabetes. In this group, the primary endpoint (MI, stroke, hospitalization for unstable angina, revascularization, or CV death) was reduced by 39% in the statin group (hazard ratio 0·61, CI 0.47–0.79, p=0·0001). The authors calculated that in the statin group, 134 vascular events or deaths were avoided  for every 54 new cases of diabetes. For the 6095 patients without a major risk factor for diabetes, the primary endpoint was reduced by 52%  (HR 0·48, CI 0.33–0.68, p=0·0001). No increase in diabetes was observed. In this group, 86 vascular events or deaths were avoided.

During the JUPITER trial, 486 subjects developed diabetes  (270 in the rosuvastatin group and 216 in the placebo group). The risk reduction in this group was consistent with the overall reduction observed in the trial.

“Our results show that in participants with and without diabetes risk, the absolute benefits of statin therapy are greater than the hazards of developing diabetes,” said Paul Ridker, in a press release issued by the Lancet. “We believe that most physicians and patients would regard heart attack, stroke and death to be more severe outcomes than the onset of diabetes, and so we hope that these results ease concern about the risks associated with statin therapy when these drugs are appropriately prescribed – in conjunction with improved diet, exercise and smoking cessation – to reduce patients’ risk of cardiovascular disease.”

The findings from JUPITER were echoed in a large observational study from Taiwan published in the Journal of the American College of Cardiology that compared 8412 people receiving statins with 33,648 matched controls. The Taiwan investigators found that although, over a median of 7.2 years, the rate of diabetes was significantly higher among statin users  (2.4% vs. 2.1%, p<0.001), statins were associated with a significant reduction in cardiovascular events (HR 0.91, CI 0.84 to 0.99, p = 0.031).

Categories: Prevention
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2 Responses to “Reports from JUPITER and Taiwan: Benefits of Statins Outweigh Risk for Diabetes”

  1. Antonio Reis, Ph.D says:
    August 14, 2012 at 9:15 am

    Please, JUPITER has no credibility at all, it exists to promote the business of Astra Zeneca. Ridker, of course!

  2. Milan Kostek, MD says:
    August 14, 2012 at 4:39 pm

    I would be reluctant to lower certain already low risk and at the same time run the risk of developing diabetes that increases the CV risk. What is the net benefit???