RAMB Julho/Agosto 2015

91 / 105

Use of statins and the incidence of type 2 diabetes mellitus
Rev Assoc Med B ras 2015; 61(4):375-380 375
REVIEW ARTICLE
Use of statins and the incidence of type 2 diabetes mellitus
André Bernardi1, Viviane Zorzanelli Rocha2, José Rocha Faria-Neto1*
1Centro de Epidemiologia e Pesquisa Clínica (EpiCenter) – Escola de Medicina, Pontifícia Universidade Católica do Paraná (PUC-PR), Curitiba, PR, Brazil
2Unidade de Lípides – Instituto do Coração (InCor)/Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
Summary
Study conducted at EpiCenter,
Pontifícia Universidade Católica do
Paraná (PUCPR), Curitiba, PR, Brazil. All
authors contributed equally for the
production of this article
Article received: 7/15/2015
Accepted for publication: 7/16/2015
*Correspondence:
Address: Av. Getúlio Vargas, 2932, cj. 1101
Curitiba, PR – Brazil
Postal code: 80240-040
Conflict of interest: none
Introduction: the use of statins is associated with reduced cardiovascular risk
in studies of primary and secondary prevention, and the reduction is directly
proportional to the reduction of LDL-cholesterol. Recent evidence suggests that
statins may be associated with a higher incidence of new cases of diabetes. The
aim of this review is to explore this possibility, identifying factors associated
with the increase in risk and the potential diabetogenic mechanisms of statins.
In addition, we evaluated if the risk of diabetes interferes with the reduction in
cardiovascular risk achieved with statins.
Methods: we reviewed articles published in the Scielo and Pubmed databases,
which assessed or described the association between use of statins and risk of
diabetes up to June 2015.
Results: use of statins is associated with a small increase in the incidence of new
cases of diabetes. Age, potency of statin therapy, presence of metabolic syndrome,
impaired fasting blood glucose, overweight and previously altered glycated he-
moglobin levels are associated with increased risk of diabetes, but there is no
consensus about the possible diabetogenic mechanisms of statins. In patients
candidate to hypolipemiant drug therapy, the benefit of reducing cardiovascu-
lar risk outweighs any risk increase in the incidence of diabetes.
Conclusion: statins are associated with a small increase in incidence of diabetes
in patients predisposed to glycemic alteration. However, since the benefit of car-
diovascular risk reduction prevails even in this group, there is no evidence to date
that this finding should change the recommendation of starting statin therapy.
Keywords: statin, diabetes mellitus, cardiovascular risk.
Introduction
Cardiovascular diseases are the leading cause of morbidity
andmortality in developed and developing countries.1 InBra-
zil, it is the leading cause of death, with deaths from cerebro-
vascular disease (mostly by cerebral ischemic stroke) and isch-
emic heart disease (mostly, acutemyocardial infarction – AMI,
accounting for 2/3 of cardiovascular deaths –Datasus, 2013).
In 2010, the death rate adjusted for age by ischemic myocar-
dial disease in men was 94/100,000, and in women,
62.8/100,000 inhabitants. In the decade from 2000 to 2010,
this mortality rate remained practically stable, with no evi-
dence of significant reduction. However, a possible growth in
this rate will be observed in the coming years, due to the in-
crease inmortality observed in some regions of the country.2
Reducing the socioeconomic impact of cardiovascu-
lar diseases, particularly those that have atherosclerosis
as their basic pathophysiology, can be achieved in two
ways: by better control of risk factors and the improved
treatment of the acute disease itself.3 Therefore, proper
treatment of changes in plasma cholesterol levels is of
fundamental importance. The increase in plasma choles-
terol is a major risk factor for AMI, 4 also contributing sig-
nificantly to vascular involvement in other arterial terri-
tories.5 Increases in the levels of cholesterol contained in
low-density lipoprotein (LDLc) are closely correlated with
increased cardiovascular risk, regardless of age.6 On the
other hand, the reduction of LDLc is clearly associated
with risk reduction, particularly with the use of statins.7
Statins reduce the concentration of LDLc by inhibit-
ing 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMG-
CoAR), leading to a proportional reduction in the risk of
cardiovascular disease.7-10 This reduction in risk is seen in
both primary prevention and secondary, as shown in a
meta-analysis conducted by the cholesterol treatment tri-