Intensive-dose statins don't confer greater diabetes risk for post-MI elderly than moderate doses

Older patients with myocardial infarction (MI) who take intensive-dose statins have the same risk of developing diabetes as those who take moderate-dose statins, a new study found.

In a retrospective study, Canadian researchers examined the records of 17,080 patients older than 65 years with acute coronary syndrome (ACS) who survived MI after hospital discharge between April 1, 2004, and March 31, 2010. They compared clinical outcomes of patients who took intensive-dose statins to those who took moderate-dose statins. The former dosage included atorvastatin ≥40 mg, rosuvastatin ≥20 mg, or simvastatin ≥60 mg. Moderate dosage included atorvastatin <40 mg, rosuvastatin <20 mg, or simvastatin <60 mg. The primary outcome was new development of diabetes after discharge; other outcomes were all-cause mortality and repeat hospitalization for ACS. Results were published online May 14 by Circulation: Cardiovascular Quality and Outcomes.

At five years, patients who took moderate-dose statins were just as likely as those who took intensive-dose statins to develop diabetes (13.0% of patients in the former group and 13.6% in the latter; P=0.19). The combined five-year mortality/ACS rate was lower in the intensive-dose group than in the moderate-dose group (44.8% vs. 46.5%; P=0.044). This combined outcome was driven mainly by a lower rate of ACS associated with intensive-dose statins (P=0.039); there was no significant difference in mortality rates (34.8% in both groups).

The findings should help allay concerns that prescribing higher doses of statins might lead to higher rates of new-onset diabetes in elderly patients with ACS, since recent studies have found a link between statins and incident diabetes, the authors noted. The intensive dose of statins is recommended by guidelines for ACS patients, and in this study significantly reduced the risk of recurrent ACS at five years with a number needed to treat of 77, they noted.