Abstract
The purpose of preventive medicine is to avert or delay the onset of disease; importantly, the benefits accrued from the preventive treatment should outweigh any risks in both the short and long-term. Disturbingly, a wealth of evidence has established that cholesterol-lowering statin drugs, widely used for the prevention of cardiovascular disease, do increase the risk of new-onset diabetes [1,2] ,p ossibly by impairing pancreaticbetacellfunctionanddecreasingperipheralinsulinsensitivity, and it has been highlighted how lowering cholesterol at the expense of increasing diabetes might be counterproductive over the long-term [3]. Recently, the diabetogenic effect of statin therapy has been rekindled when a large randomized placebo-controlled primary prevention trial, Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), revealed that subjects randomized to rosuvastatin 20 mg daily over the 1.9-year trial developed a significantly higher incidence of new-onset diabetes [4]. In fact, a post hoc analysis of the JUPITER trial concluded that the positive, although multiple and composite, cardiovascular benefits of statin-treated subjects outweighed theriskofdevelopingdiabetes[5].However,a closerlookatthe JUPITER's data suggests that in clinical practice, the beneficial effects of statin therapy do not outweigh the risk of diabetes, even in short-term. The analysis of participants from the JUPITER trial, to address the balance of vascular benefits and diabetes hazard of statin use after a median follow-up of 2 years, found that rosuvastatin therapy was associated with 65 fewer major vascular events (MVE) or deaths at no risk of diabetes in the 6095 participants with no major diabetes risk factors, and with 93 fewer MVE or deaths at a cost of 54 new diagnoses of
Published Version
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