Statin Use And Risk Of Developing Diabetes: A Network Meta-Analysis

Abstract

A137 with maternal hypertension. Early diagnosis and treatment through regular antenatal check-up is a key factor to prevent PIH and its complications. Interventions to improve maternal health through information, education and counselling of women of child bearing age should be implemented.Objectives: Increased perioperative blood pressure (BP) variability in cardiac surgery is associated with negative clinical outcomes and increased health resource utilization (HRU). Clevidipine, an ultrashort-acting, arterial selective calcium channel blocker reduces BP variability and may reduce HRU in this setting. The current model evaluates the one year budget impact of adding clevidipine to an intravenous antihypertensive (IVAH) treatment mix in a sample US hospital. MethOds: A spreadsheet model was developed using treatment specific HRU data from a clevidipine clinical trial (ECLIPSE) in cardiac surgery. Treatment distribution for IVAH agents (clevidipine, nicardipine, nitroglycerin, and nitroprusside), case volumes and comparable IVAH dosages were obtained from the Premier Hospital database. Unit costs for IVAH are US Wholesale Acquisition Costs (WAC). Thirtyday event costs were from the published literature. The model inputs may be customized to more accurately represent a given healthcare system. Results: The base case assumed a sample hospital with 468 coronary artery bypass graft (CABG) cases and 322 heart valve (HV) cases annually. Clevidipine usage in the base case was minimal (0% in CABG; 1% in HV). The base case predicts a one year total cost of $19,045,453 with the largest proportion of costs from general ward, ICU and operative suite time (approx. 30%, 21%, and 20% respectively). One year IVAH costs totaled $93,958 or 0.5% of total costs. Increasing the proportion of cases receiving clevidipine to 5% for both procedures increased drug acquisition costs by $13,005 and decreased HRU-related costs by $48,439 for a net decrease in costs of $35,434 for one year. cOnclusiOns: This analysis predicts a net savings with an increase in clevidipine use. In this example case, a minimal increase in IVAH costs was offset by savings in HRU-related costs resulting from improved outcomes associated with reduced perioperative BP variability.

Exercise training prevents skeletal muscle plasma membrane cholesterol accumulation, cortical actin filament loss, and insulin resistance in C57BL/6J mice fed a western-style high-fat diet

“…Notably, statins increase LPL serum mass and activity in T2D (Endo et al 2004). Perhaps these findings offer some explanation as to why some statins increase, albeit modestly, the risk of T2D (Thakker et al 2016). Together, these studies demonstrate evidence implicating a change in cholesterol metabolism, favoring intracellular cholesterol accumulation, as a potential risk factor for T2D.…”

“…As to why lipid lowering drugs, such as statins, are associated with increased incidence of new on-set diabetes remains imperfectly understood, yet mechanisms have been proposed and discussed in the literature (Brault et al 2014;Robinson 2015). Interestingly, nearly two decades of randomized, control trials and meta-analyses have revealed that the risk is not the same among statins with atorvastatin, simvastatin, and rosuvastatin being the most diabetogenic, lovastatin and fluvastatin having an intermediate risk, and pravastatin and pitavastatin having the lowest diabetogenicity (Millan Nunez-Cortes et al 2016;Thakker et al 2016). In fact, basic and clinical data suggest that these least diabetogenic statins, especially pitavastatin, may even exhibit a positive effect on glucose metabolism (Teramoto 2011;Daido et al 2014;Huang et al 2016).…”

National Trends in Statin Medication Prescribing in Patients With a History of Stroke or Transient Ischemic Attack

“…Of note, rosuvastatin was the only statin to independently display a significant increase in the risk of new onset diabetes (pooled OR: 1.18; 95% CI: 1.04-1.33; P = .009; 4 RCTs). 15 However, baseline hemoglobin levels, additional risk factors for the development of diabetes, and risks versus benefits of statin therapy initiation must be considered.…”

Statin use and safety concerns: an overview of the past, present, and the future

“…Another meta-analysis of observational studies reported similar findings (RR 1.44, CI 1.31-1.58; I 2 = 97%) [79] and also described it as a class effect with rosuvastatin and atorvastatin reportedly associated with the highest risk. This was also shown in a network meta-analysis from 2016 (pooled OR 1.12, CI 1.05-1.21; I 2 = 36%) that reported the highest risk with atorvastatin 80 mg (OR 1.34, CI 1.14-1.57), followed by higher and lower doses of rosuvastatin (OR 1.17, CI 1.02-1.35) and simvastatin (OR 1.13, CI 0.99-1.29) [80] (Table 1). A 2011 meta-analysis of 5 statin trials with 32,752 non-diabetic patients reported a greater diabetics incidence associated with intensive statin dose compared to the moderate dose [76].…”