We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Statin Therapy Dose and Risk of New-Onset Diabetes—Reply

David Preiss, MRCP; Sreenivasa Rao Kondapally Seshasai, MD; Kausik K. Ray, MD
JAMA. 2011;306(12):1325-1326. doi:10.1001/jama.2011.1355.
Text Size: A A A
Published online


In Reply: We agree with Dr McEvoy that meta-analysis, by design, cannot establish causation, although the fact that our 2 meta-analyses have included data from 18 randomized trials for more than 120 000 patients1 suggests that the link between statin therapy and new-onset diabetes may be causal. Other proposed explanations for our observations have included survival bias, differential ascertainment of diabetes between trial groups (patients experiencing more adverse effects in 1 group leading them to interact with clinicians more often), and the possibility that patients in some trials were aware of allocated treatment (leading those who receive intensive therapy to adopt poorer lifestyles with resultant weight gain). However, we demonstrated that hazard ratios and odds ratios for new-onset diabetes were identical and that the 25% and 44% increases in new-onset diabetes noted in JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; rosuvastatin, 20 mg, vs placebo) and SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels; atorvastatin, 80 mg, vs placebo),2,3 respectively, occurred despite almost identical numbers of adverse events between treatment groups. Data from JUPITER show that those individuals receiving the statin were only marginally (0.3-kg) heavier than those receiving placebo at the end of the trial (an unlikely explanation for the observed 25% increase in diabetes). The biological plausibility of statins affecting glucose homeostasis is supported by studies from an animal model that suggest a possible effect on insulin signaling.4


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




September 28, 2011
John W. McEvoy, MBBCh
JAMA. 2011;306(12):1325-1326. doi:10.1001/jama.2011.1354.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.