Systematic review
Three meta-analyses published between 2009 and 20112–4 suggested that all statins are associated with a small increase in the risk of incident type 2 diabetes (hazard ratio [HR] 1·09, 95% CI 1·02–1·17),3 and that intensive-dose statin therapy is associated with higher risk than is lower dose therapy (HR 1·12, 95% CI 1·04–1·22).4 In absolute terms, however, these risks are low compared with the absolute benefit of statin therapy in the setting of secondary prevention, from which most data are derived. We were unable to find any data directly addressing the cardiovascular benefits and diabetes risks in the setting of primary prevention, an issue that has caused much controversy in both the medical and lay press. Further, we were unable to find any data addressing whether the risks and benefits of statin therapy in primary prevention differ between people with and without risk factors for diabetes.