他汀类药物与新发糖尿病之间的关系

Relationship between Statins and New Onset Diabetes Mellitus

摘要: 观察性研究、随机对照临床试验及meta分析表明，中等强度的他汀类药物使NOD风险增加约11%，其中有12%的人可能会转而服用高强度他汀类药物，因此与安慰剂组相比，高强度的他汀类药物可能使NOD风险增加20%或更多。而这其中有许多其他变量参与。但他汀类药物可能导致NOD发生的机制尚未完全明确。遗传学研究将HMG-CoA还原酶抑制与糖尿病风险和体重增加联系起来。除外，我们对被研究最广泛的潜在机制，即他汀类药物诱导的胰岛素抵抗的理解仍然远远不完整。而且，许多数据来源于分离的细胞系统或动物模型中的体外研究，其可能与人类相关或不相关。当医生给患者开他汀类药物处方时，应该警告患者该药物有轻微的糖尿病风险，并告诉他们适度的生活方式改善既可消除他汀类药物的糖尿病风险，也可改善他汀类药物以外的心血管风险。医生还应检测患者他汀类药物使用后的血糖情况，包括最常见的HbA1c、FBG，并根据检查结果制定患者的生活方式和护理措施。

Abstract: Observational studies, randomized controlled clinical trials, and meta-analysis have shown that moderate intensity statins increase the risk of NOD by around 11% with a potential further 12% moving to high-intensity statins, such that high intensity may increase risk by 20% or more relative to placebo. There are many other variables involved in this. However, the mechanism by which statins may cause NOD has not been not fully understood. Genetic studies have linked HMG- CoA reductase inhibition to diabetes risk and weight gain. In addition, our understanding of the most widely studied underlying mechanism, statin induced insulin resistance, is still far from complete; moreover, much data derives from in vitro studies in isolated cell systems or animal models, which may or may not be relevant to humans. Patients should be warned about a slight diabetes risk when prescribed statin and told that modest lifestyle improvements can not only nullify diabetes risk, but also improve cardiovascular risks beyond statins. Doctors should also measure glycemia status post statin commencement, most commonly with HbA1c、FBG, and tailor lifestyle advice and care de-pendent on the results.