How does this help?
This morning several of the wire services reported on a study published online by the respected diabetes journal, The Lancet. Most of the reports started with a headline that stated the use of statins increases the risk of developing type 2 diabetes. Given that statins are the most widely used prescription medication it’s no surprise that wire services would go for attention grabbing headlines. Upon closer examination it appears once again the main stream media isn’t letting the facts get in the way of a good story.
According to the authors of the study who concluded; “In view of the overwhelming benefit of statins for reduction of cardiovascular events, the small absolute risk for development of diabetes is outweighed by cardiovascular benefit in the short and medium term in individuals for whom statin therapy is recommended. We therefore suggest that clinical practice for statin therapy does not need to change for patients with moderate or high cardiovascular risk or existing cardiovascular disease. However, the potentially raised diabetes risk should be taken into account if statin therapy is considered for patients at low cardiovascular risk or patient groups in which cardiovascular benefit has not been proven.”
Before we go further Diabetic Investor would like everyone to reread the author’s conclusion and pay close attention to the last sentence; “However, the potentially raised diabetes risk should be taken into account if statin therapy is considered for patients at low cardiovascular risk or patient groups in which cardiovascular benefit has not been proven.”
Next it’s equally important to note how the authors conducted the study using the ever popular meta-analysis, the same method used by Dr. Nissen and his team when their meta-analysis showed there may be an increased risk of cardiovascular events for patients on Avandia, and we all know what happened to Avandia after that. This time around the authors looked at thirteen trials from 1994 to 2009 and according to their analysis statin therapy was associated with a 9% increased risk for developing diabetes.
Just to make things even more fun Dr Christopher P Cannon, Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston; and TIMI Study Office, Boston, MA, added in an corresponding note that this study projected that 5•4 deaths or heart attacks would be avoided over those four years. Also, nearly the same number of strokes or coronary revascularization procedures would also be avoided. Dr Cannon states; “Thus the benefit [of taking statins] in preventing total vascular events to the risk of diabetes is a ratio of about 9:1 in favor of the cardiovascular benefit. Thus the benefit seems to greatly outweigh the risk.”
He notes in closing: “Nonetheless, this newly identified risk does warrant monitoring, and as such, in addition to periodic monitoring of liver-function tests and creatine kinase, it seems reasonable to add glucose to the list of tests to monitor in older patients on statins. Thus, whilst a new risk of statins has been identified, the risk seems small and far outweighed by the benefits of this life-saving class of drugs.”
Looking over this study and reflecting back on the Avandia controversy, which as noted above was also sparked by another meta-analysis, Diabetic Investor is reminded of something Andrew Lang wrote long ago; “He uses statistics as a drunken man uses lampposts – for support rather than illumination.”
So just are we to make of this recent meta-analysis or put another way has this study actually benefited patients with diabetes or people taking statins in general? Some may recall studies that concluded that patients with diabetes should also be taking a statin to reduce cardiovascular risks. And will someone please explain to Diabetic Investor how exactly it helps patients and the physicians who treat them the benefit of double talk. On the one hand the authors and Dr. Cannon correctly point out the many benefits of statins, yet both go onto to state that the use of statins carries an increased risk of developing diabetes.
As Diabetic Investor has stated on too many occasions there is no such thing as a completely risk free drug. Time and time again we have learned that many widely prescribed medications carry with them an element of risk, this is the nature of the beast. This is particularly true with medications used to treat diabetes. As everyone knows diabetes, even when well controlled, is associated with several co-morbidities.
A perfect example of this came when it was reported there may be a link between Byetta usage and pancreatitis. As is happening here the main stream media went for the attention grabbing headlines without first checking all the facts. Had they done so they would have discovered that patients with diabetes on a whole are at greater risk of developing pancreatitis just because they have diabetes. Had they bothered to do even the smallest amount of research they would have also discovered that patients taking Byetta actually experienced a lower incidence of developing pancreatitis than the general diabetes population. Simply put there was no factual evidence that Byetta usage actually caused the pancreatitis.
Nonetheless the general public along with many physicians, who don’t have the time to read all the research, believed there was link between Byetta and pancreatitis. Not surprisingly sales of Byetta suffered as result. And we all know that meta-analysis by Dr. Nissen effectively killed a multi-billion dollar franchise for GlaxoSmithKline (NYSE:GSK).
So we ask again; now that we know there is a small risk of developing diabetes for people using statins, how does this help? Or put another way, does this “knowledge” benefit the patient using statins or does it give them just another reason not to take the very medication that could be saving their lives? The way things are going it wouldn’t surprise Diabetic Investor if a group of researchers are studying the link between breathing and developing diabetes.
When it comes to this most recent meta-analysis we are reminded of a statement made by many; “You can never know too little of what is not worth knowing at all.”