Statin Therapy and the Risks of New-Onset Type 2 Diabetes. Henry N. Ginsberg, MD; Eliot A. Brinton, MD

Patients with cardiometabolic risk factors, such as type 2 diabetes or metabolic syndrome, often have mixed dyslipidemia accompanied by other cardiovascular risk factors. Dyslipidemia in the patient with type 2 diabetes not only contributes to atherosclerotic risk, but also to the development and progression of microvascular disease, including diabetic retinopathy and nephropathy. Despite the strength of evidence supporting lipid-modifying therapy for reduction of coronary heart disease risk in these patients, appropriate implementation of therapy is inconsistent and a large proportion of patients fail to achieve their lipid goals. Furthermore, evidence suggests that more than 40% of diabetics with mixed dyslipidemia are not receiving lipid-modifying therapy. Post-hoc evaluation of statin trials has revealed that the use of certain statins has been linked with a substantial increase in blood glucose as shown by elevated hemoglobin A1c, and increased incidence of new-onset diabetes. The difficulty of achieving lipid targets while maintaining a favorable safety and tolerability profile has led to the development of novel statins that lack negative glycemic effects.

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