The Effect Of Statins On Glucose: A Meta-Analysis

BackgroundTo date, Statins rank among the most frequently prescribed drugs in today’s clinical practice regarding its effects on plasma cholesterol,Besides their main effect of lowering atherogenic LDL-cholesterol levels, statins have a number of pleiotropic effects, which may contribute to the vascular benefits; however, to which extent pleiotropic statin effects translate into a clinically meaningful benefit remains a matter of debate. There are conflicting data from large-scale randomized placebo-controlled trials and small clinical studies with regard to the impact of many components of this class,on the glycemic status of various populations, including atoravastatin, simvastatin and rosuvastatin,. More data are needed to reach safe conclusions as for the actual effect of lovastatin, pitavastatin and fluvastatin on glycemic control of various patients.To date, there is no global consensus as to the effect of statin treatment on glycemic control and the risk of diabetes.Therefore, more studies are needed to reach safe conclusions with regard to the effect of each statin on HbAlc level and glycemic status.Objectives:This meta-analysis was designed to assess the effect of statins on glucose and HbAlc, in order to provide additional evidence for clinical doctors’ decision.MethodsWe conducted a search in pubmed and Conchrane Controlled Trials Register(CCRT).All randomized drug controlled using statins and reported glucose and/or HbAlc measurements were selected. The comparative changes in glucose or HbAlc for statin with placebo therapy were calculated. Results were expressed as weighted mean differences (WMD) or standard mean difference(SMD)with95%confidence intervals (CI). P<0.05was considered statistically significant. ResultsA total of45randomized controlled trials (RCT) were included. Among them,3studies were about rosuvastatin,20studies were about atorvastatin,13studies were about simvastatin,1study was about lovastatin,9studies were about provastatin,1study was about flovastatin.1.The effect of rosuvastatinCompared with placebo, rosuvastatin has no influence on glucose(SMD=0.25;95%CI:[-0.01,0.52], P=0.06),but can slightly increase the glycated hemoglobin level(WMD=0.07;95%CI:[0.01,0.13], P=0.02).2.The effect of atrovastatinCompared with placebo,atrovastatin has no influence on glucose(SMD=0.17;95%CI:[-0.17,0.52], P=0.32), but can slightly increase the glycated hemoglobin level (WMD=0.17;95%CI:[0.12,0.23], P<0.00001).Subgroup analyses:atrovastatin has no influence on glucose both in DM and non-DM patient, but middle and high dose of atrovastatin can slightly increase the glucose.3.The effect of simvastatinCompared with placebo, simvastatin has no influence on glucose(SMD=0.32;95%CI:[-0.18,0.82], P=0.21), also has no influence on the glycated hemoglobin level(WMD=0.1;95%CI:[-0.02,0.23], P=0.1).Subgroup analyses:compared with placebo, simvastatin has no influence on DM patient,but can slightly increase the glucose level on non-DM patient.4.The effect of lovastatinCompared with placebo, lovastatin has no influence both on glucose and glycated hemoglobin level.5.The effect of provastatinCompared with placebo, provastatin has no influence on glucose(SMD=-0.25;95%CI:[-0.55,0.05], P=0.11), also has no effect on glycated hemoglobin level(WMD=-0.07;95%CI:[-0.15,0.02], P=0.12) 6.The effect of flovastatinCompared with placebo,flovastatin has no influence both on glucose and glycated hemoglobin level.Conclusions1.Compared with placebo, rosuvastatin has no influence on glucose, but can slightly increase the glycated hemoglobin level.2.Compared with placebo,atrovastatin has no influence on glucose,but can slightly increase the glycated hemoglobin level. Subgroup analyses:atrovastatin has no influence on glucose both in DM and non-DM patient,but middle and high dose of atrovastatin can slightly increase the glucose.3.Compared with placebo,simvastatin has no influence both on glucose and glycated hemoglobin level.Subgroup analyses:compared with placebo,simvastatin has no influence on DM patient,but can slightly increase the glucose level on non-DM patient.4.Compared with placebo,lovastatin has no influence both on glucose and glycated hemoglobin level.5.Compared with placebo,provastatin has no influence both on glucose and glycated hemoglobin level.6.Compared with placebo,flovastatin has no influence both on glucose and glycated hemoglobin level.