Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial
Open accessAbstract
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)
Experimental — accuracy not yet measuredThe 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)
Experimental — accuracy not yet measuredAn 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).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [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).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [158]
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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
- PMC
- PMC3774022
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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