The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice
Por:
Sattar, NA, Ginsberg, H, Ray, K, Chapman, MJ, Arca, M, Averna, M, Betteridge, DJ, Bhatnagar, D, Bilianou, E, Carmena, R, Ceska, R, Corsini, A, Erbel, R, Flynn, PD, Garcia-Moll, X, Gumprecht, J, Ishibashi, S, Jambart, S, Kastelein, JJP, Maher, V, da Silva, PM, Masana, L, Odawara, M, Pedersen, TR, Rotella, CM, Salti, I, Teramoto, T, Tokgozoglu, L, Toth, PP, Valensi, P, Verges, B
Publicada:
1 jun 2014
Resumen:
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. (C) 2014 Published by Elsevier Ireland Ltd.
Filiaciones:
Sattar, NA:
Univ Glasgow, BHF Glasgow Cardiovasc Res Ctr, Inst Cardiovasc & Med Sci, 126 Univ Pl, Glasgow G12 8TA, Lanark, Scotland
Ginsberg, H:
Columbia Univ Coll Phys & Surg, Irving Inst Clin & Translat Res, New York, NY 10032 USA
Ray, K:
St Georges Univ London, Cardiovasc Sci Res Ctr, London SW17 0RE, England
Chapman, MJ:
Pitie Salpetriere Univ Hosp, INSERM, UMR S939, Dyslipidemia & Atherosclerosis Res Unit, F-75651 Paris, France
Arca, M:
Univ Roma La Sapienza, Dept Internal Med & Allied Sci, I-00161 Rome, Italy
Averna, M:
Univ Palermo, Sch Med, Dept Internal Med & Med Specialties, I-90133 Palermo, Italy
Betteridge, DJ:
Middlesex Hosp, Univ Coll London, London, England
Bhatnagar, D:
Royal Oldham Hosp, Ctr Diabet, Oldham, Greater Manches, England
Bilianou, E:
Tzanio Hosp, Dept Cardiol, Lipid Clin, Piraeus, Greece
Carmena, R:
Univ Valencia, Dept Med, E-46003 Valencia, Spain
Ceska, R:
Charles Univ Prague, Dept Int Med 3, Ctr Prevent Cardiol, Prague, Czech Republic
Univ Gen Hosp, Prague, Czech Republic
Corsini, A:
Univ Milan, Dipartimento Sci Farmacol & Biomol, Milan, Italy
Erbel, R:
Univ Essen Gesamthsch, Dept Cardiol, West German Heart Ctr, Essen, Germany
Flynn, PD:
Addenbrookes Hosp, Lipid Clin, Cambridge CB0 2QQ, England
Garcia-Moll, X:
Hosp Santa Creu & Sant Pau, Unit Hospitalitzacio, Serv Cardiol, Barcelona, Spain
Gumprecht, J:
Slaski Uniwersytet Med, Katedra Klin Chorob Wewetrznych Diabetol & Nefrol, Katowice, Poland
Ishibashi, S:
Jichi Med Univ, Dept Internal Med, Div Endocrinol & Metab, Yakushiji Shimotsuke, Tochigi 3290498, Japan
Jambart, S:
St Joseph Univ, Fac Med, Beirut, Lebanon
Hotel Dieu France Hosp, Div Endocrinol & Metab, Beirut, Lebanon
Kastelein, JJP:
Univ Amsterdam, Acad Med Ctr, Dept Vasc Med, NL-1105 AZ Amsterdam, Netherlands
Maher, V:
Tallaght Hosp, Dept Cardiol, Dublin, Ireland
da Silva, PM:
CHLC, Santa Martas Hosp, Arterial Invest Unit, Lisbon, Portugal
Masana, L:
Univ Rovira & Virgili, CIBERDEM, IISPV, Unitat Recerca Lipids & Arteriosclerosi, E-43201 Reus, Spain
Odawara, M:
Tokyo Med Univ, Dept Internal Med 3, Div Diabetol Endocrinol & Metab, Shinjuku Ku, Tokyo 1600023, Japan
Green Published
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