{"id":27067,"date":"2012-03-05T14:23:15","date_gmt":"2012-03-05T19:23:15","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&p=27067"},"modified":"2012-03-05T14:23:15","modified_gmt":"2012-03-05T19:23:15","slug":"statins-and-diabetes-real-concern-or-much-ado-about-nothing","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/03\/05\/statins-and-diabetes-real-concern-or-much-ado-about-nothing\/","title":{"rendered":"Statins and Diabetes: Real Concern or Much Ado About Nothing?"},"content":{"rendered":"

In\u00a0a\u00a0New York Times<\/em>\u00a0Op-Ed piece on Monday<\/a>, Eric Topol comments on last week\u2019s announcement by the FDA that it was changing the label for statins. Topol focuses on the new warning that statins raise the risk of diabetes. He opens with a provocative statement:<\/p>\n

We\u2019re overdosing on cholesterol-lowering statins, and the consequence could be a sharp increase in the incidence of Type 2 diabetes.<\/p><\/blockquote>\n

Topol does the math and calculates that 20 million Americans taking statins equates to 100,000 new statin-induced diabetics:<\/p>\n

Not a good thing for the public health and certainly not good for the individual affected with a new serious chronic illness\u2026\u00a0If there were a major suppression of heart attacks or strokes or deaths, that might be justified. But in patients who have never had heart disease and are taking statins to lower their risk (so-called primary prevention), the reduction of heart attacks and other major events is only 2 per 100. And we don\u2019t know who the 2 per 100 patients are who benefit or the one per 200 who will get diabetes! Moreover, the margin of benefit to risk is quite narrow.<\/p><\/blockquote>\n

Topol then concludes that statins are beneficial for secondary prevention in people with a history of heart disease or stroke but for “the vast majority of people who take statins — those who have never had any heart disease — there should be a careful review of whether the statin is necessary, in light of the risk of diabetes and the relatively small benefit that can be derived.”<\/p>\n

On\u00a0his blog on Forbes<\/a>, pharma reporter Matt Herper writes that with the editorial Topol “has broken ranks with many other heart doctors.” It should be noted, though, that statins for primary prevention have been the subject of intense debate in the past, most recently in\u00a0an exchange in the\u00a0Wall Street Journal<\/em>\u00a0between cardiologists Rita Redberg and Roger Blumenthal<\/a>. In addition, the FDA action and Topol\u2019s piece relied on long-available data.<\/p>\n

In a comment highlighted by Herper on his blog, Sanjay Kaul looks at the same numbers as Topol and concludes that “the patients who develop diabetes (1 in 200) are more likely to have elevated fasting blood sugar at baseline, and these patients are also likely to benefit from satins (2 in 100).”<\/p>\n

In his\u00a0own\u00a0<\/em>blog on Forbes<\/a>,\u00a0John LaMattina, who was the\u00a0president of Pfizer Global Research and Development in Lipitor’s prime, also disputes Topol\u2019s conclusions. He points out the presence of “a very compelling clinical trial showing the value of one statin, Lipitor (atorvastatin), in Type 2 diabetes — the Collaborative Atorvastatin Diabetes Study — known as CARDS.” The study was stopped early when it showed large reductions in acute coronary events and mortality for atorvastatin when compared with placebo in diabetics with no history of cardiovascular disease.<\/p>\n","protected":false},"excerpt":{"rendered":"

In\u00a0a\u00a0New York Times\u00a0Op-Ed piece on Monday, Eric Topol comments on last week\u2019s announcement by the FDA that it was changing the label for statins. Topol focuses on the new warning that statins raise the risk of diabetes. He opens with a provocative statement: We\u2019re overdosing on cholesterol-lowering statins, and the consequence could be a sharp […]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[200,665,584],"class_list":["post-27067","post","type-post","status-publish","format-standard","hentry","category-prevention","tag-diabetes","tag-primary-prevention","tag-statins"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/27067","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=27067"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/27067\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=27067"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=27067"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=27067"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}