Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines.

Academic Medical Center University of Amsterdam Dept of Vascular Medicine F4 159 2 Meibergdreef 9 1105 AZ Amsterdam The Netherlands

Arterial Investigation Unit Medicine 4 Santa Marta's Hospital CHLC Lisboa Portugal

Cardiovascular Sciences Research Centre St Georges University of London Cranmer Terrace London SW17 0RE UK

Center of Preventive Cardiology 3rd Dept Int Med Charles University and University General Hospital Prague Czech Republic

Department of Cardiology Tallaght Hospital Dublin Ireland

Department of Cardiology West German Heart Centre University of Essen Germany

Department of Endocrinology Diabetology Nutrition APHP CRNH IdF CINFO Paris Nord University Bondy France

Department of Endocrinology University of Florence Medical School Italy

Department of Internal Medicine and Allied Sciences Sapienza University of Rome Viale del Policlinico 155 00161 Rome Italy

Department of Internal Medicine Division of Endocrinology and Metabolism Jichi Medical University 3311 1 Yakushiji Shimotsuke shi Tochigi 329 0498 Japan

Department of Medicine University of Valencia Spain

Dept of Internal Medicine and Medical Specialties School of Medicine University of Palermo Italy

Diabetes Centre The Royal Oldham Hospital Rochdale Road Oldham UK

Dipartimento di Scienze Farmacologiche e Biomolecolari Università degli Studi di Milano Milan Italy

Division of Diabetology Endocrinology and Metabolism The 3rd Department of Internal Medicine Tokyo Medical University 6 7 1 Nisi shinjuku Shinjuku ku Tokyo 160 0023 Japan

Division of Endocrinology and Metabolism American University of Beirut Lebanon

Dyslipidemia and Atherosclerosis Research Unit INSERM UMR S939 Pitie Salpetriere University Hospital 75651 Paris France

Institute of Cardiovascular and Medical Sciences BHF Glasgow Cardiovascular Research Centre University Of Glasgow 126 University Place Glasgow G12 8TA UK

Irving Institute for Clinical and Translational Research PH 10 305 Columbia University College of Physicians and Surgeons 630 West 168th Street New York NY 10032 USA

Katedra i Klinika Chorób Wewętrznych Diabetologii i Nefrologii Śląski Uniwersytet Medyczny Katowice Poland

Lipid Clinic Cardiology Department Tzanio Hospital Pireas Greece

Professor of Cardiology Hacettepe University Çankaya Ankara Turkey

Service Endocrinologie Diabétologie et Maladies Métaboliques University Hospital Dijon France

St Joseph University Faculty of Medicine and Head Endocrinology and Metabolism Division Hotel Dieu de France Hospital Beirut Lebanon

Teikyo University Teikyo Academic Research Center Japan

The Lipid Clinic Box 153 Addenbrooke's Hospital Cambridge CB0 2QQ UK

Unitat de Recerca en Lipids i Arteriosclerosi IISPV CIBERDEM Universitat Rovira i Virgili Sant Llorenç 21 43201 Reus Spain

Unitat Hospitalització Servei de Cardiologia Hospital de la Santa Creu i Sant Pau Spain

University College London Middlesex Hospital London UK

University of Illinois College of Medicine Peoria IL USA

University of Oslo and Oslo University Hospital Ullevål Centre of Preventive Medicine Medical Clinic Oslo Norway

Citace poskytuje Crossref.org

Statins, glycemia, and diabetes mellitus: another point of view