一項(xiàng)薈萃分析研究數(shù)據(jù)顯示，使用他汀類致新發(fā)糖尿病風(fēng)險(xiǎn)增加會(huì)因劑量和藥物類型而有差異。研究結(jié)果1月25日在線發(fā)表于《美國心臟病學(xué)雜志》(The American Journal of Cardiology)。

與安慰劑相比，普伐他汀40 mg/d致糖尿病的風(fēng)險(xiǎn)最低(比值比1.07)。風(fēng)險(xiǎn)最高的是瑞舒伐他汀40 mg/d(比值比1.25)。中等風(fēng)險(xiǎn)的是阿托伐他汀80 mg/d(比值比1.15)。

與中等劑量方案相比，劑量較大方案致糖尿病風(fēng)險(xiǎn)普遍增加。例如，瑞舒伐他汀20 mg/d的相對(duì)風(fēng)險(xiǎn)比10 mg/d高12%。

牽頭進(jìn)行該研究的Eliano P. Navarese博士表示，這項(xiàng)薈萃分析首次明確顯示“致糖尿病風(fēng)險(xiǎn)與他汀類的不同劑量及類型存在梯度相關(guān)。”

波蘭彼得哥什市哥白尼大學(xué)的Navarese博士和同事研究了包括11.3萬多名受試者的17項(xiàng)隨機(jī)對(duì)照試驗(yàn)的數(shù)據(jù)，這些試驗(yàn)比較了他汀類與安慰劑或不同劑量的他汀類治療結(jié)果。隨訪范圍為2~6年。

在臨床意義方面，Navarese博士指出，“如果這項(xiàng)網(wǎng)絡(luò)薈萃分析的結(jié)果能夠在效能足夠的頭對(duì)頭比較中被證實(shí)，那將對(duì)全球數(shù)百萬接受他汀類治療的患者的管理具有重要意義。一種新的他汀類治療方案可能會(huì)出現(xiàn)，那時(shí)個(gè)體化他汀類治療有可能成為最安全有效的治療策略。”

Meta-Analysis of Impact of Different Types and Doses of Statins on New-Onset Diabetes Mellitus.

Recent reports indicate that statins are associated with an increased risk for new-onset diabetes mellitus (DM) compared with placebo and that this relation is dose dependent. The aim of this study was to perform a comprehensive network meta-analysis of randomized controlled trials (RCTs) investigating the impact of different types and doses of statins on new-onset DM. RCTs comparing different types and doses of statins with placebo were searched for using the MEDLINE, Embase, and Cochrane databases. A search of RCTs pertinent to this meta-analysis covering the period from November 1994 to October 2012 was conducted by 2 independent investigators using the MEDLINE, Cochrane, Google Scholar, and Embase databases as well as abstracts and presentations from major cardiovascular meetings. Seventeen RCTs reporting the incidence of new-onset DM during statin treatment and including a total of 113,394 patients were identified. The RCTs compared either a statin versus placebo or high-dose versus moderate-dose statin therapy. Among different statins, pravastatin 40 mg/day was associated with the lowest risk for new-onset DM compared with placebo (odds ratio 1.07, 95% credible interval 0.86 to 1.30). Conversely, rosuvastatin 20 mg/day was numerically associated with 25% increased risk for DM compared with placebo (odds ratio 1.25, 95% credible interval 0.82 to 1.90). The impact on DM appeared to be intermediate with atorvastatin 80 mg/day compared with placebo (odds ratio 1.15, 95% credible interval 0.90 to 1.50). These findings were replicated at moderate doses. In conclusion, different types and doses of statins show different potential to increase the incidence of DM.