Maki Kevin C, Diwadkar-Navsariwala Veda, Kramer Melvyn W
a Department of Metabolic Sciences , Midwest Biomedical Research Center for Metabolic and Cardiovascular Health , Glen Ellyn , IL , USA.
b Department of Endocrinology , MB Clinical Research , Boca Raton , FL , USA.
Postgrad Med. 2018 Mar;130(2):166-172. doi: 10.1080/00325481.2018.1402658. Epub 2017 Nov 22.
Statins are the first line of pharmacologic treatment for the management of hypercholesterolemia in patients at risk for atherosclerotic cardiovascular (CV) disease. In recent years, several randomized, controlled trials (RCTs) and observational studies have reported increased risk for new-onset type 2 diabetes mellitus (T2D) with statin treatment, particularly with use of high-intensity statins that reduce low-density lipoprotein cholesterol (LDL-C) by 50% or more. This paper summarizes the data from RCTs and observational studies for statin-associated T2D risk, and puts into perspective this evidence, weighed against the established benefits of statin therapy for CV risk reduction. In RCTs, the increase in T2D risk with statin therapy appears to be attributable mainly to those with major T2D risk factors. The increase in incidence of T2D in those with major risk is approximately 25% for statin use, compared to placebo, and for intensive statin therapy compared to moderate-intensity statin therapy. However, in those with major T2D risk factors, the number of CV disease events prevented for each excess case of T2D is close to or greater than one, indicating that the risk-benefit ratio still strongly favors use of statin therapy, or intensive statin therapy, for patients with sufficient CV disease risk to warrant cholesterol-lowering drug therapy. Recommendations are summarized for evaluation of the T2D risk factor profile before initiation of and during statin therapy. In addition, the importance of lifestyle management and other preventive measures is emphasized for management of risks for both T2D and CV disease events in patients receiving statin therapy.
他汀类药物是治疗有动脉粥样硬化性心血管（CV）疾病风险患者高胆固醇血症的一线药物治疗方法。近年来，多项随机对照试验（RCT）和观察性研究报告称，他汀类药物治疗会增加新发2型糖尿病（T2D）的风险，尤其是使用能将低密度脂蛋白胆固醇（LDL-C）降低50%或更多的高强度他汀类药物时。本文总结了RCT和观察性研究中关于他汀类药物相关T2D风险的数据，并结合他汀类药物治疗降低CV风险的既定益处，对这一证据进行了客观分析。在RCT中，他汀类药物治疗导致的T2D风险增加似乎主要归因于那些有主要T2D风险因素的患者。与安慰剂相比，使用他汀类药物的主要风险患者中T2D发病率增加约25%，与中等强度他汀类药物治疗相比，高强度他汀类药物治疗时也是如此。然而，在有主要T2D风险因素的患者中，每多出现一例T2D所预防的CV疾病事件数量接近或超过一个，这表明风险效益比仍强烈支持对有足够CV疾病风险、需要进行降胆固醇药物治疗的患者使用他汀类药物治疗或高强度他汀类药物治疗。本文总结了在开始他汀类药物治疗前和治疗期间评估T2D风险因素的建议。此外，强调了生活方式管理和其他预防措施对于接受他汀类药物治疗患者的T2D和CV疾病事件风险管理的重要性。
