J Y Cui1, R R Zhou1, S Han1, T S Wang1, L Q Wang1, X H Xie1. 1. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
Abstract
WHAT IS KNOWN AND OBJECTIVE: Statins are the cornerstone of primary and secondary prevention of cardiovascular diseases (CVDs) and are effective for the prevention of vascular events in diabetic patients. Diabetes mellitus is an important risk factor for CVDs .The majority of patients with diabetes mellitus benefits from statin therapy. According to the recent clinical guidelines of the American College of Cardiology and the American Heart Association, moderate-intensity or high-intensity statin therapy should be used as the primary prevention for individuals with diabetes mellitus, aged between 40 and 75 years and with low-density lipoprotein cholesterol (LDL-C) from 70 to 189 mg/dL. The objective of this review was to compare the associations of individual statins with their adverse effects on glycemic control in patients with type 2 diabetes mellitus (T2DM). METHODS: MEDLINE, EMBASE and CENTRAL were searched from inception through March 2017. There were included randomized controlled trials comparing statins with placebo or active comparators in patients with T2DM. The endpoints of interest were glycated haemoglobin A1C (HbA1C ) and fasting plasma glucose (FPG). We performed a pairwise meta-analysis and a network meta-analysis within a frequentist framework. The standard mean differences (SMD) and 95% confidence intervals (CI) were calculated. RESULTS: Twenty-three trials were included. A significant increase in HbA1c was detected in the pairwise meta-analysis when statins as a class were compared with placebo (SMD: 0.11). Moderate-intensity pitavastatin lowered HbA1c compared with moderate-intensity atorvastatin (SMD: -0.16), high-intensity atorvastatin (SMD: -0.77), moderate-intensity rosuvastatin (SMD: -0.16) and low-intensity pravastatin (SMD: -0.15). Moderate-intensity simvastatin lowered HbA1c compared with high-intensity rosuvastatin (SMD: -0.45) and high-intensity atorvastatin (SMD: -0.77). High-intensity atorvastatin elevated HbA1c compared with placebo (SMD: 0.63), moderate-intensity rosuvastatin (SMD: 0.50), low-intensity pravastatin (SMD: 0.51) and moderate-intensity atorvastatin (SMD: 0.50). Moderate-intensity pitavastatin has lowered FPG compared with placebo (SMD: -0.55), moderate-intensity rosuvastatin (SMD: -0.65), moderate-intensity atorvastatin (SMD: -0.65) and high-intensity atorvastatin (SMD: -1.25). High-intensity atorvastatin has elevated FPG compared with placebo (SMD: 0.70), moderate-intensity atorvastatin (SMD: 0.60), moderate-intensity rosuvastatin (SMD: 0.60) and moderate-intensity simvastatin (SMD: 0.90). WHAT IS NEW AND CONCLUSION: Statins were associated with an increase in HbA1c compared with placebo. In patients with T2DM, moderate-intensity pitavastatin improved the glycemic control whereas high-intensity atorvastatin worsened it. Appropriate statins should be administered for patients with diabetes mellitus.
WHAT IS KNOWN AND OBJECTIVE: Statins are the cornerstone of primary and secondary prevention of cardiovascular diseases (CVDs) and are effective for the prevention of vascular events in diabeticpatients. Diabetes mellitus is an important risk factor for CVDs .The majority of patients with diabetes mellitus benefits from statin therapy. According to the recent clinical guidelines of the American College of Cardiology and the American Heart Association, moderate-intensity or high-intensity statin therapy should be used as the primary prevention for individuals with diabetes mellitus, aged between 40 and 75 years and with low-density lipoprotein cholesterol (LDL-C) from 70 to 189 mg/dL. The objective of this review was to compare the associations of individual statins with their adverse effects on glycemic control in patients with type 2 diabetes mellitus (T2DM). METHODS: MEDLINE, EMBASE and CENTRAL were searched from inception through March 2017. There were included randomized controlled trials comparing statins with placebo or active comparators in patients with T2DM. The endpoints of interest were glycated haemoglobin A1C (HbA1C ) and fasting plasma glucose (FPG). We performed a pairwise meta-analysis and a network meta-analysis within a frequentist framework. The standard mean differences (SMD) and 95% confidence intervals (CI) were calculated. RESULTS: Twenty-three trials were included. A significant increase in HbA1c was detected in the pairwise meta-analysis when statins as a class were compared with placebo (SMD: 0.11). Moderate-intensity pitavastatin lowered HbA1c compared with moderate-intensity atorvastatin (SMD: -0.16), high-intensity atorvastatin (SMD: -0.77), moderate-intensity rosuvastatin (SMD: -0.16) and low-intensity pravastatin (SMD: -0.15). Moderate-intensity simvastatin lowered HbA1c compared with high-intensity rosuvastatin (SMD: -0.45) and high-intensity atorvastatin (SMD: -0.77). High-intensity atorvastatin elevated HbA1c compared with placebo (SMD: 0.63), moderate-intensity rosuvastatin (SMD: 0.50), low-intensity pravastatin (SMD: 0.51) and moderate-intensity atorvastatin (SMD: 0.50). Moderate-intensity pitavastatin has lowered FPG compared with placebo (SMD: -0.55), moderate-intensity rosuvastatin (SMD: -0.65), moderate-intensity atorvastatin (SMD: -0.65) and high-intensity atorvastatin (SMD: -1.25). High-intensity atorvastatin has elevated FPG compared with placebo (SMD: 0.70), moderate-intensity atorvastatin (SMD: 0.60), moderate-intensity rosuvastatin (SMD: 0.60) and moderate-intensity simvastatin (SMD: 0.90). WHAT IS NEW AND CONCLUSION: Statins were associated with an increase in HbA1c compared with placebo. In patients with T2DM, moderate-intensity pitavastatin improved the glycemic control whereas high-intensity atorvastatin worsened it. Appropriate statins should be administered for patients with diabetes mellitus.