Primary prevention with statins and incident diabetes in hypertensive patients at high cardiovascular risk

Background and aims: The ESC/ESH guidelines for arterial hypertension recommend using statins for patients with high cardiovascular (CV) risk for both secondary and primary prevention. A recent meta-analysis, combining previous studies on statins, concluded that they are associated with a 9% increased risk of incident type 2 diabetes mellitus (DM). There is no information on whether statins increase incidence of DM in primary prevention. Method and results: We evaluated risk of incident DM in relation to statin prescription in 4750 hypertensive, non-diabetic outpatients (age 58.57 +/- 9.0 yrs, 42.3% women), from the CampaniaSalute Network, without chronic kidney disease more than grade 3, free of prevalent CV disease and with at least 12 months of follow-up. DM was defined according to ADA criteria. At the end of follow-up period (55.78 +/- 42.5 months), 676 patients (14%) were on statins. These patients were older (62.54 +/- 7.3 vs 57.91 +/- 9.1 yrs; p < 0.0001), more often female (49% vs 41.2%; p = 0.0001), with higher initial total cholesterol (217.93 +/- 44.3 vs 205.29 +/- 36.6 mg/dl), non-HDL cholesterol (167.16 +/- 44.5 vs 155.18 +/- 36.7 mg/dl) and triglycerides (150.69 +/- 85.2 vs 130.98 +/- 72.0 mg/dl; all p < 0.0001) than patients no taking statins, without other differences in clinical and laboratory characteristics. At the end of follow-up, prevalence of DM was 18.1% among patients on statins and 7.2% among those without lipidlowering therapy (p < 0.0001). However, incident DM was 10.2% in patients on statins and 8.7% in those free of statin therapy (NS). Conclusion: In real-life outpatient environment, statin prescription for primary prevention is not associated with increased risk of incident DM. (C) 2012 Elsevier B.V. All rights reserved.