Author + information
- Yajnavalka Banerjee, PhD* ()
- ↵*Department of Biochemistry, SQ University, Oman, P.O. Box 35, Muscat, Muscat 123, Oman
The study by Wang et al. (1) assessed the risk of diabetes associated with statin use in the general population. The authors concluded that statin therapy is associated with an elevated risk for diabetes. However, the study does not indicate the classes or proportion of the different antihypertensive drugs (AHDs) administered in the statin-treated and control populations. This information is imperative because thiazide diuretics and specific beta-blockers exhibit undesirable glycemic effects.
Assessment of the ALLHAT study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) revealed that the 4-year incidence of new-onset diabetes mellitus was significantly elevated in the chlorthalidone group compared with either the amlodipine or lisinopril group (11.6% vs. 9.8% and 8.1%, respectively; p < 0.05) (2). Comparable outcomes were also obtained from the INSIGHT (International Nifedipine GITS Study of Intervention as a Goal in Hypertension Treatment) and ASCOT-BPLA (Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm) trials (3,4). These effects of diuretic AHDs on glucose metabolism are plausibly due to hypokalemia induced by these drugs.
Hyperglycemia induced by beta-blockers is due to the reduction in peripheral blood flow, followed by the channeling of blood away from locales of glucose uptake, thereby reducing glucose clearance. A systematic review by Elliott and Meyer (5), with 48 randomized groups of 22 clinical trials involving 143,153 participants, revealed that association of AHDs with incident diabetes is the highest for beta-blockers and diuretics (in rank order).
Therefore, the question that remains unrequited in the current study – “Is the adverse glycemic effect of statins observed in the present study getting augmented, as a greater number of subjects in the statin-group are being treated for hypertension with diuretics or beta-blockers?”
Furthermore, a prospective population-based cohort study by Dunder et al. (6) examined the impact of blood glucose elevation on the risk of developing myocardial infarction in individuals between 50 and 60 years of age who were receiving AHDs. They found that the elevated blood glucose and proinsulin levels produced by use of diuretics and beta-blockers were linked to the increased risk of myocardial infarction in these subjects. Therefore, in the current study, if the statin-treated group has a higher number of subjects receiving diuretics and beta-blockers, then the favorable outcome of statins may be further augmented.
- American College of Cardiology Foundation
- Wang K.L.,
- Liu C.J.,
- Chao T.F.,
- et al.
- ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group
- Dahlof B.,
- Sever P.S.,
- Poulter N.R.,
- et al.
- Dunder K.,
- Lind L.,
- Zethelius B.,
- Berglund L.,
- Lithell H.