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• Statin use in postmenopausal women is associated with a significantly increased risk of diabetes mellitus, according to new data provided by the Women's Health Initiative (WHI), whose research suggests that the risk of diabetes is higher than previously estimated, with investigators reporting a 48% increased risk of diabetes among the women taking the lipid-lowering medications. Read article by theHeart.org: click here.
• What is the appropriate response to this research?
• Will this create a need to convince patients that the heart benefits of statins outweigh diabetes risk?

I think the real conundrum with this WHI paper which is gaining notariety in the national media is how our female patients will respond particularly the high CV risk patient.  Secondly - as lipid specialists we need to respect that this reported trend in increased diabetes incidence is more than just flawed trial design but likely due in part to some of the previously posited mechanisms (e.g. increased isoprenoid synthesis, increased insulin secretion with statin therapy).  I think as lipid-centric clinicians our first response will probably be to staunchly defend statin therapy but I also think we need to consider statin risk-benefit and at baseline pretreatment patient variables such as A1C, CRP, and fasting glucose - particularly with moderate CV risk patients and even more specifically at patients with prediabetes.  Still, and admittedly I am conficted here, based specifically on JUPITER outcomes (38% were women) we are obliged to balance this modest increase in diabetes risk to major macrovascular benefits because those in JUPITER that had impaired fasting glucose (at study entry) had large and highly significant reductions in MI, srtoke and CV mortality associated with rosuvastatin therapy.  Finally - it will be interesting to see how will the ATP IV panel view this issue with regard to statin risk/benefit.