This Week in Cardiology Apr 05 2024 This Week in Cardiology
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Apr 5, 2024 
Cardiologist John Mandrola discusses statins and diabetes, AADs in heart disease patients, tricuspid valve interventions, and an ACC preview. Topics include statin therapy's link to new onset diabetes, efficacy of statin trials, FDA approval of TriClip for tricuspid regurgitation, and upcoming ACC trials like the danger shock trial comparing Impella vs. standard care in cardiogenic shock.
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Statin Diabetes Signal Is Modest And Contextual
- The CTT meta-analysis found statins modestly increase new diabetes diagnoses, larger with high-intensity therapy but absolute risks remain small.
- Statin cardiovascular benefits outweigh this modest glycemic effect because MACE outcomes already incorporate diabetes-related harms.
Detection Bias May Inflate Diabetes Risk
- High-intensity statin trials showed a larger proportional diabetes increase but also used more frequent HbA1c measurements, which may inflate detection.
- Many new diagnoses clustered near diagnostic thresholds, suggesting detection and thresholds drive some signal.
Frame Statin Risk As Absolute And Net Benefit
- When discussing statins with patients, emphasize absolute risk and cardiovascular benefit rather than relative diabetes risk alone.
- Explain that trials' broad MACE endpoints capture diabetes harms, so focus decisions on net cardiovascular outcomes.