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Risk of incident diabetes among patients treated with statins: population based study.
BMJ 2013; 346:f2610BMJ

Abstract

OBJECTIVE

To examine the risk of new onset diabetes among patients treated with different HMG-CoA reductase inhibitors (statins).

DESIGN

Population based cohort study with time to event analyses to estimate the relation between use of particular statins and incident diabetes. Hazard ratios were calculated to determine the effect of dose and type of statin on the risk of incident diabetes.

SETTING

Ontario, Canada.

PARTICIPANTS

All patients aged 66 or older without diabetes who started treatment with statins from 1 August 1997 to 31 March 2010. The analysis was restricted to new users who had not been prescribed a statin in at least the preceding year. Patients with established diabetes before the start of treatment were excluded.

INTERVENTIONS

Treatment with statins.

MAIN OUTCOME MEASURE

Incident diabetes.

RESULTS

Compared with pravastatin (the reference drug in all analyses), there was an increased risk of incident diabetes with atorvastatin (adjusted hazard ratio 1.22, 95% confidence interval 1.15 to 1.29), rosuvastatin (1.18, 1.10 to 1.26), and simvastatin (1.10, 1.04 to 1.17). There was no significantly increased risk among people who received fluvastatin (0.95, 0.81 to 1.11) or lovastatin (0.99, 0.86 to 1.14). The absolute risk for incident diabetes was about 31 and 34 events per 1000 person years for atorvastatin and rosuvastatin, respectively. There was a slightly higher [corrected] absolute risk with simvastatin (26 outcomes per 1000 person years) compared with pravastatin (23 outcomes per 1000 person years). Our findings were consistent regardless of whether statins were used for primary or secondary prevention of cardiovascular disease. Although similar results were observed when statins were grouped by potency, the risk of incident diabetes associated with use of rosuvastatin became non-significant (adjusted hazard ratio 1.01, 0.94 to 1.09) when dose was taken into account.

CONCLUSIONS

Compared with pravastatin, treatment with higher potency statins, especially atorvastatin and simvastatin, might be associated with an increased risk of new onset diabetes.

Authors+Show Affiliations

Toronto General Hospital, Toronto, ON, Canada M5G 2C4.No affiliation info availableNo 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

23704171

Citation

Carter, Aleesa A., et al. "Risk of Incident Diabetes Among Patients Treated With Statins: Population Based Study." BMJ (Clinical Research Ed.), vol. 346, 2013, pp. f2610.
Carter AA, Gomes T, Camacho X, et al. Risk of incident diabetes among patients treated with statins: population based study. BMJ. 2013;346:f2610.
Carter, A. A., Gomes, T., Camacho, X., Juurlink, D. N., Shah, B. R., & Mamdani, M. M. (2013). Risk of incident diabetes among patients treated with statins: population based study. BMJ (Clinical Research Ed.), 346, pp. f2610. doi:10.1136/bmj.f2610.
Carter AA, et al. Risk of Incident Diabetes Among Patients Treated With Statins: Population Based Study. BMJ. 2013 May 23;346:f2610. PubMed PMID: 23704171.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of incident diabetes among patients treated with statins: population based study. AU - Carter,Aleesa A, AU - Gomes,Tara, AU - Camacho,Ximena, AU - Juurlink,David N, AU - Shah,Baiju R, AU - Mamdani,Muhammad M, Y1 - 2013/05/23/ PY - 2013/5/25/entrez PY - 2013/5/25/pubmed PY - 2013/7/31/medline SP - f2610 EP - f2610 JF - BMJ (Clinical research ed.) JO - BMJ VL - 346 N2 - OBJECTIVE: To examine the risk of new onset diabetes among patients treated with different HMG-CoA reductase inhibitors (statins). DESIGN: Population based cohort study with time to event analyses to estimate the relation between use of particular statins and incident diabetes. Hazard ratios were calculated to determine the effect of dose and type of statin on the risk of incident diabetes. SETTING: Ontario, Canada. PARTICIPANTS: All patients aged 66 or older without diabetes who started treatment with statins from 1 August 1997 to 31 March 2010. The analysis was restricted to new users who had not been prescribed a statin in at least the preceding year. Patients with established diabetes before the start of treatment were excluded. INTERVENTIONS: Treatment with statins. MAIN OUTCOME MEASURE: Incident diabetes. RESULTS: Compared with pravastatin (the reference drug in all analyses), there was an increased risk of incident diabetes with atorvastatin (adjusted hazard ratio 1.22, 95% confidence interval 1.15 to 1.29), rosuvastatin (1.18, 1.10 to 1.26), and simvastatin (1.10, 1.04 to 1.17). There was no significantly increased risk among people who received fluvastatin (0.95, 0.81 to 1.11) or lovastatin (0.99, 0.86 to 1.14). The absolute risk for incident diabetes was about 31 and 34 events per 1000 person years for atorvastatin and rosuvastatin, respectively. There was a slightly higher [corrected] absolute risk with simvastatin (26 outcomes per 1000 person years) compared with pravastatin (23 outcomes per 1000 person years). Our findings were consistent regardless of whether statins were used for primary or secondary prevention of cardiovascular disease. Although similar results were observed when statins were grouped by potency, the risk of incident diabetes associated with use of rosuvastatin became non-significant (adjusted hazard ratio 1.01, 0.94 to 1.09) when dose was taken into account. CONCLUSIONS: Compared with pravastatin, treatment with higher potency statins, especially atorvastatin and simvastatin, might be associated with an increased risk of new onset diabetes. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/23704171/Risk_of_incident_diabetes_among_patients_treated_with_statins:_population_based_study_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=23704171 DB - PRIME DP - Unbound Medicine ER -