Statine e rischio di diabete mellito di nuova insorgenza in adulti con fattori di rischio cardiovascolare

I dati relativi al potenziale aumento del rischio di sviluppare diabete mellito (DM) a seguito dell'inizio della terapia con statine sono ancora contrastanti. Attraverso lo studio Kaiser Permanente Cholesterol-lowering Therapy in High-Risk Adults: Management and Patient Risks (KP CHAMP Study) è stata valutata questa possibile associazione, selezionando soggetti adulti non diabetici, con fattori di rischio cardiovascolare e che non assumevano terapia ipolipemizzante tra il 2008 e il 2010. Tra i 213.289 soggetti eleggibili, 28.149 pazienti, che hanno iniziato la terapia con statina, sono stati appaiati con un ugual numero di pazienti che non avevano iniziato la terapia durante il periodo di follow up. Sebbene il tasso grezzo (per 100 anni-persona) di casi incidenti di diabete mellito di nuova insorgenza (NODM) era basso (0,55; IC 95% 0,52-0,59), risultava leggermente maggiore tra i nuovi utilizzatori di statine (0,69; 0,64-0,74) rispetto ai non utilizzatori (0,42; 0,38-0,46). In seguito ad aggiustamenti per potenziali fattori confondenti, la terapia con statina rimaneva associata in modo indipendente ad un modesto aumento del rischio di sviluppare NODM (HR 1,17; 1,02-1,34).

Statin Therapy and Risk of Incident Diabetes Mellitus in Adults With Cardiovascular Risk Factors

Go AS, Ambrosy AP, Kheder K, Fan D, Sung SH, Inveiss AI, Romo-LeTourneau V, Thomas SM, Koren A, Lo JC; Kaiser Permanente Cholesterol-Lowering Therapy in High-Risk Adults: Management and Patient Risks (KP CHAMP) Studys.

Am J Cardiol. 2020;125:534-541

The association between statins and diabetes mellitus (DM) remains controversial. The Kaiser Permanente CHAMP Study identified adults without DM who had cardiovascular (CV) risk factors and no previous lipid lowering therapy (LLT) between 2008 and 2010. The CV risk factors included known atherosclerotic CV disease (ASCVD), elevated low-density lipoprotein cholesterol =190 mg/dl, or a low-density lipoprotein cholesterol between 70 and 189 mg/dl and an estimated 10-year ASCVD risk =7.5%. Incident DM was defined as =2 abnormal tests (i.e., A1C =6.5% or a fasting blood glucose =126 mg/dl) or =1 abnormal test result plus a new diagnostic code or medication for DM. Among 213.289 eligible adults, 28.149 patients initiating statins were carefully matched to an equal number of patients who remained off LLT during follow-up. Compared with matched patients not receiving statins, those initiating statin therapy had the same mean age (67.9 ± 9.4 years) and gender (42.8% women). The crude rate (per 100 person-years) of incident DM was low (0.55, 95% confidence interval [CI] 0.52 to 0.59) but was marginally higher in patients who were treated with a statin (0.69, 95% CI 0.64 to 0.74) versus no LLT (0.42, 95% CI 0.38 to 0.46). After additional adjustment, statin therapy was associated with a modestly increased risk of incident DM (adjusted hazard ratio 1.17, 95% CI 1.02 to 1.34). In conclusion, in adults without DM at increased ASCVD risk, initiation of statin therapy was independently associated with a modestly higher risk of incident DM.

Am J Cardiol. 2020;125:534-541