Bernardi André, Rocha Viviane Zorzanelli, Faria-Neto José Rocha
Centro de Epidemiologia e Pesquisa Clínica, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, BR.
Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
Rev Assoc Med Bras (1992). 2015 Aug;61(4):375-80. doi: 10.1590/1806-9282.61.04.375.
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.
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.
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 hemoglobin 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 cardiovascular risk outweighs any risk increase in the incidence of diabetes.
statins are associated with a small increase in incidence of diabetes in patients predisposed to glycemic alteration. However, since the benefit of cardiovascular risk reduction prevails even in this group, there is no evidence to date that this finding should change the recommendation of starting statin therapy.
在一级和二级预防研究中，他汀类药物的使用与心血管风险降低相关，且这种降低与低密度脂蛋白胆固醇的降低成正比。近期证据表明，他汀类药物可能与新发糖尿病病例的更高发生率相关。本综述的目的是探讨这种可能性，确定与风险增加相关的因素以及他汀类药物潜在的致糖尿病机制。此外，我们评估了糖尿病风险是否会干扰他汀类药物在降低心血管风险方面所取得的成效。
我们查阅了在Scielo和Pubmed数据库中发表的文章，这些文章评估或描述了截至2015年6月他汀类药物使用与糖尿病风险之间的关联。
他汀类药物的使用与新发糖尿病病例的发生率小幅增加相关。年龄、他汀类药物治疗的强度、代谢综合征的存在、空腹血糖受损、超重以及先前糖化血红蛋白水平改变与糖尿病风险增加相关，但关于他汀类药物可能的致糖尿病机制尚无共识。在适合进行降血脂药物治疗的患者中，降低心血管风险的益处超过糖尿病发生率任何增加的风险。
他汀类药物与血糖易发生改变的患者中糖尿病发生率小幅增加相关。然而，由于即使在该组中降低心血管风险的益处仍然占优，迄今为止没有证据表明这一发现应改变启动他汀类药物治疗的推荐。
