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Statins and new-onset diabetes: a retrospective longitudinal cohort study.
Clin Ther 2012; 34(9):1977-83CT

Abstract

BACKGROUND

Statins have been linked to new-onset diabetes (NOD); however, the effect of statins on the development of NOD in patients with hypertension and dyslipidemia has not been well studied.

OBJECTIVE

The goal of this study was to investigate the association between statins and NOD.

METHODS

This was a retrospective cohort study performed by using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan from July 2006 to December 2009. Prescriptions for statins before the index date were retrieved from a prescription database. We estimated the hazards ratios (HRs) of NOD associated with statin use. Nondiabetic subjects served as the reference group.

RESULTS

A total of 1360 (8.5%) NOD cases were identified among 16,027 patients with hypertension and dyslipidemia during the study period. The risk of NOD after adjusting for sex and age was higher among users of pravastatin (HR, 1.34 [95% CI, 1.15-1.55]) and atorvastatin (HR, 1.29 [95% CI, 1.16-1.44]) than among nonusers. Patients who took fluvastatin (HR, 0.45 [95% CI, 0.34-0.60]), lovastatin (HR, 0.71 [95% CI, 0.61-0.84]), and rosuvastatin (HR, 0.54 [95% CI, 0.39-0.77]) were at lower risk of developing NOD than nonusers. Simvastatin was not associated with risk of NOD. Furthermore, the risk of NOD after adjusting for concomitant medication usage and mean dose of statins was neutral among users of atorvastatin. Pravastatin, fluvastatin, lovastatin, simvastatin, and rosuvastatin produced similar results as adjusting for sex and age.

CONCLUSIONS

These outpatients with hypertension and dyslipidemia who took fluvastatin, lovastatin, and rosuvastatin were at lower risk of NOD, whereas patients who took pravastatin were at greater risk. Simvastatin and atorvastatin seemed to have a neutral effect. Our study also demonstrated that atorvastatin has a dose-response effect on NOD risk. Because this was a descriptive study, temporality and subsequent causality of all statins and NOD could not be shown. Further study and independent confirmation of the causality between statin use and NOD in larger clinical trials are warranted.

Authors+Show Affiliations

Department of Health Service Management, China Medical University, Taichung, Taiwan, Republic of China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22939164

Citation

Ma, Tsochiang, et al. "Statins and New-onset Diabetes: a Retrospective Longitudinal Cohort Study." Clinical Therapeutics, vol. 34, no. 9, 2012, pp. 1977-83.
Ma T, Tien L, Fang CL, et al. Statins and new-onset diabetes: a retrospective longitudinal cohort study. Clin Ther. 2012;34(9):1977-83.
Ma, T., Tien, L., Fang, C. L., Liou, Y. S., & Jong, G. P. (2012). Statins and new-onset diabetes: a retrospective longitudinal cohort study. Clinical Therapeutics, 34(9), pp. 1977-83. doi:10.1016/j.clinthera.2012.08.004.
Ma T, et al. Statins and New-onset Diabetes: a Retrospective Longitudinal Cohort Study. Clin Ther. 2012;34(9):1977-83. PubMed PMID: 22939164.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Statins and new-onset diabetes: a retrospective longitudinal cohort study. AU - Ma,Tsochiang, AU - Tien,Liyun, AU - Fang,Chih-Ling, AU - Liou,Yi-Sheng, AU - Jong,Gwo-Ping, Y1 - 2012/08/30/ PY - 2012/03/20/received PY - 2012/07/30/revised PY - 2012/08/10/accepted PY - 2012/9/4/entrez PY - 2012/9/4/pubmed PY - 2013/2/6/medline SP - 1977 EP - 83 JF - Clinical therapeutics JO - Clin Ther VL - 34 IS - 9 N2 - BACKGROUND: Statins have been linked to new-onset diabetes (NOD); however, the effect of statins on the development of NOD in patients with hypertension and dyslipidemia has not been well studied. OBJECTIVE: The goal of this study was to investigate the association between statins and NOD. METHODS: This was a retrospective cohort study performed by using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan from July 2006 to December 2009. Prescriptions for statins before the index date were retrieved from a prescription database. We estimated the hazards ratios (HRs) of NOD associated with statin use. Nondiabetic subjects served as the reference group. RESULTS: A total of 1360 (8.5%) NOD cases were identified among 16,027 patients with hypertension and dyslipidemia during the study period. The risk of NOD after adjusting for sex and age was higher among users of pravastatin (HR, 1.34 [95% CI, 1.15-1.55]) and atorvastatin (HR, 1.29 [95% CI, 1.16-1.44]) than among nonusers. Patients who took fluvastatin (HR, 0.45 [95% CI, 0.34-0.60]), lovastatin (HR, 0.71 [95% CI, 0.61-0.84]), and rosuvastatin (HR, 0.54 [95% CI, 0.39-0.77]) were at lower risk of developing NOD than nonusers. Simvastatin was not associated with risk of NOD. Furthermore, the risk of NOD after adjusting for concomitant medication usage and mean dose of statins was neutral among users of atorvastatin. Pravastatin, fluvastatin, lovastatin, simvastatin, and rosuvastatin produced similar results as adjusting for sex and age. CONCLUSIONS: These outpatients with hypertension and dyslipidemia who took fluvastatin, lovastatin, and rosuvastatin were at lower risk of NOD, whereas patients who took pravastatin were at greater risk. Simvastatin and atorvastatin seemed to have a neutral effect. Our study also demonstrated that atorvastatin has a dose-response effect on NOD risk. Because this was a descriptive study, temporality and subsequent causality of all statins and NOD could not be shown. Further study and independent confirmation of the causality between statin use and NOD in larger clinical trials are warranted. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/22939164/Statins_and_new_onset_diabetes:_a_retrospective_longitudinal_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(12)00485-7 DB - PRIME DP - Unbound Medicine ER -