Cited by 816Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsCancer, Lipids, and Metabolism

Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial

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Ridker, Paul M, Pradhan, Aruna, MacFadyen, Jean G, Libby, Peter, Glynn, Robert J·2012·The Lancet

Abstract

Background In view of evidence that statin therapy increases risk of diabetes, the balance of benefit and risk of these drugs in primary prevention has become controversial. We undertook an analysis of participants from the JUPITER trial to address the balance of vascular benefits and diabetes hazard of statin use. Methods In the randomised, double-blind JUPITER trial, 17,603 men and women without previous cardiovascular disease or diabetes were randomly assigned to rosuvastatin 20 mg or placebo and followed up for up to 5 years for the primary endpoint (myocardial infarction, stroke, admission to hospital for unstable angina, arterial revascularisation, or cardiovascular death) and the protocol-prespecified secondary endpoints of venous thromboembolism, all-cause mortality, and incident physician-reported diabetes. In this analysis, participants were stratified on the basis of having none or at least one of four major risk factors for developing diabetes: metabolic syndrome, impaired fasting glucose, body-mass index 30 kg/m(2) or higher, or glycated haemoglobin A(1c) greater than 6%. The trial is registered at ClinicalTrials.gov, NCT00239681. Findings Trial participants with one or more major diabetes risk factor (n=11,508) were at higher risk of developing diabetes than were those without a major risk factor (n=6095). In individuals with one or more risk factors, statin allocation was associated with a 39% reduction in the primary endpoint (hazard ratio [HR] 0·61, 95% CI 0·47-0·79, p=0·0001), a 36% reduction in venous thromboembolism (0·64, 0·39-1·06, p=0·08), a 17% reduction in total mortality (0·83, 0·64-1·07, p=0·15), and a 28% increase in diabetes (1·28, 1·07-1·54, p=0·01). Thus, for those with diabetes risk factors, a total of 134 vascular events or deaths were avoided for every 54 new cases of diabetes diagnosed. For trial participants with no major diabetes risk factors, statin allocation was associated with a 52% reduction in the primary endpoint (HR 0·48, 95% CI 0·33-0·68, p=0·0001), a 53% reduction in venous thromboembolism (0·47, 0·21-1·03, p=0·05), a 22% reduction in total mortality (0·78, 0·59-1·03, p=0·08), and no increase in diabetes (0·99, 0·45-2·21, p=0·99). For such individuals, a total of 86 vascular events or deaths were avoided with no new cases of diabetes diagnosed. In analysis limited to the 486 participants who developed diabetes during follow-up (270 on rosuvastatin vs 216 on placebo; HR 1·25, 95% CI 1·05-1·49, p=0·01), the point estimate of cardiovascular risk reduction associated with statin therapy (HR 0·63, 95% CI 0·25-1·60) was consistent with that for the trial as a whole (0·56, 0·46-0·69). By comparison with placebo, statins accelerated the average time to diagnosis of diabetes by 5·4 weeks (84·3 [SD 47·8] weeks on rosuvastatin vs 89·7 [50·4] weeks on placebo). Interpretation In the JUPITER primary prevention trial, the cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard, including in participants at high risk of developing diabetes. Funding AstraZeneca.

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  • The absolute risk increase was small: over 5 years of follow-up, 1.2% of participants on placebo developed diabetes and 1.5% on rosuvastatin developed diabetes.

    “The absolute risk increase was small (over 5 years of follow-up, 1.2% of participants on placebo developed diabetes and 1.5% on rosuvastatin developed diabetes) (164).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [164]

    The Results report more diabetes diagnoses with rosuvastatin than placebo (270 versus 216), supporting the direction of the increase. They do not report the claimed 1.5% and 1.2% participant risks. The Methods describe follow-up of up to five years, not five years for every participant. (LLM, conf=0.88)

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  • The absolute risk increase of incident diabetes with rosuvastatin was small: over 5 years of follow-up, 1.2% of participants on placebo developed diabetes and 1.5% on rosuvastatin developed diabetes.

    “The absolute risk increase was small (over 5 years of follow-up, 1.2% of participants on placebo developed diabetes and 1.5% on rosuvastatin developed diabetes) (158).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [158]

    The Results report more incident diabetes with rosuvastatin than placebo (270 versus 216 cases), supporting a small absolute increase. But the paper does not report that 1.5% and 1.2% of participants developed diabetes over five years: the Methods say follow-up was up to five years, and the Discussion says median follow-up was two years. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • An analysis of one of the initial studies suggested that although statin use was associated with diabetes risk, the cardiovascular event rate reduction with statins far outweighed the risk of incident diabetes, even for individuals at highest risk for diabetes.

    “An analysis of one of the initial studies suggested that although statin use was associated with diabetes risk, the cardiovascular event rate reduction with statins far outweighed the risk of incident diabetes, even for individuals at highest risk for diabetes (164).”
  • An analysis of one initial study suggested that although statin use was associated with diabetes risk, the cardiovascular event rate reduction with statins far outweighed the risk of incident diabetes, even for individuals at highest risk for diabetes.

    “An analysis of one of the initial studies suggested that although statin use was associated with diabetes risk, the cardiovascular event rate reduction with statins far outweighed the risk of incident diabetes, even for individuals at highest risk for diabetes (158).”

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Research works printed but not linked: 8

  1. [4]Preiss D Seshasai SRK Wels P Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy JAMA 2011 305 2556 64 21693744
  2. [6]Glynn RJ Danielson E Fonseca FA A randomized trial of rosuvastatin in the prevention of venous thromboembolism N Engl J Med 2009 360 1851 61 19329822 PMC2710995
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  4. [8]Glynn RJ Koenig W Nordestgaard BG Shepherd J Ridker PM Rosuvastatin for primary prevention in older persons with elevated C-reactive protein and low to average low-density lipoprotein cholesterol levels: Exploratory analysis of a randomized trial Ann Intern Med 2010 152 488 96 20404379 PMC2946369
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Authors
Ridker, P. M., Pradhan, A., MacFadyen, J. G., Libby, P., & Glynn, R. J.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Ridker, Paul M
Venue
The Lancet
Publisher
Elsevier BV
Published
2012-08
Volume
380
Issue
9841
Pages
565-571
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2164750952
Cited by
816
References
3
Citations by year
2026: 25 · 2025: 36 · 2024: 46 · 2023: 40 · 2022: 51 · 2021: 43 · 2020: 36 · 2019: 68 · 2018: 46 · 2017: 51 · 2016: 82 · 2015: 80 · 2014: 101 · 2013: 88 · 2012: 19
FWCI
94.05
Type
journal article
Language
en
Open access
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • AstraZeneca
  • National Heart, Lung, and Blood Institute (R01HL103742)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
Keywords
statin therapy, rosuvastatin, JUPITER trial, primary prevention, cardiovascular risk, diabetes risk, benefit-risk balance, diabetes risk factors, metabolic syndrome, impaired fasting glucose, venous thromboembolism, all-cause mortality, cardiovascular events, statin-induced diabetes, hypertriglyceridemia, LDL cholesterol lowering, C-reactive protein
MeSH terms
Rosuvastatin Calcium, Aged, Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Double-Blind Method, Female, Fluorobenzenes, Humans, Male, Middle Aged, Pyrimidines, Risk Factors, Sulfonamides, United States, Incidence, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Venous Thromboembolism

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