BMJ Study: CV benefits of statin use far exceed risks

The potential cardiovascular benefits of long-term statin use outweigh the low risks -  including muscle toxicity, diabetes, and dementia - associated with these drugs, stated a report published recently in the British Medical Journal.

In a review of the literature spanning 20 years, the authors, from the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Md., found a modest increase in the occurrence of myositis and rhabdomyolysis, but not myalgia, concomitant with statin use in randomized controlled trials. However, in the case of rhabdomyolysis, the risk was associated with high-dose statin use (simvastatin 80 mg), which is no longer recommended, since publication of an FDA advisory.

“Statin-associated myopathy also occurs at a higher rate in patients who are concurrently prescribed drugs that interact with statins to increase their effective blood level,” said Chintan S. Desai, a clinical cardiology fellow at The Johns Hopkins Hospital, and his colleagues.

Diabetes risk

The authors also noted a modest increase in the risk of diabetes associated with statin use, as indicated by results of the randomized clinical trials and meta-analyses they examined. However, the increased risk of diabetes has been found to be limited to individuals who already are at high risk of contracting the disease. In the JUPITER study, these individuals had at least one risk factor for diabetes, such as impaired fasting glucose, a body mass index higher than 30, metabolic syndrome, or HbA1c greater than 6%.

“The most recent U.S. guidelines acknowledge the increased risk of diabetes with statins and recommend that individuals on statin therapy be evaluated for new-onset diabetes according to current diabetes screening guidelines,” the authors wrote.

The dose and potency of a statin regimen also have an effect on diabetes risk. A meta-analysis revealed that individuals who received intensive doses of statins had a 12% increased risk of diabetes compared to those receiving moderate doses of statin therapy.

Two years ago, FDA warned of a risk of memory loss and confusion associated with statins, basing its warning on small randomized studies and observational data. Randomized clinical trials have indicated no significant difference in cognitive function between those receiving statins and the control groups.