Statins, Risk of Diabetes, and Implications on Outcomes in the General Population
This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population. Cardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occu...
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| Published in | Journal of the American College of Cardiology Vol. 60; no. 14; pp. 1231 - 1238 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
New York, NY
Elsevier Inc
02.10.2012
Elsevier Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0735-1097 1558-3597 1558-3597 |
| DOI | 10.1016/j.jacc.2012.05.019 |
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| Abstract | This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population.
Cardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occurrence according to clinical trial analyses. From daily-practice perspectives, it remains unclear whether statin use increases risk; prognoses of diabetes after exposure require further clarification.
From Taiwan National Health Insurance beneficiaries age ≥45 years (men) and ≥55 years (women) before 2004, subjects continuously treated with statins ≥30 days during 2000 to 2003 and nonusers before 2004 were identified. Among nondiabetic individuals at the cohort entry, controls were matched to statin users on a 4:1 ratio by age, sex, atherosclerotic comorbidities, and year of their entry. Outcomes as diabetes, major adverse cardiovascular events (MACE, the composite of myocardial infarction and ischemic stroke), and in-hospital deaths were assessed.
Over a median of 7.2 years, annual rates of diabetes were significantly higher in statin users (2.4% vs. 2.1%, p < 0.001), whereas MACE (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.68 to 0.98 for myocardial infarction; HR: 0.94; 95% CI: 0.86 to 1.03 for ischemic stroke; HR: 0.91; 95% CI: 0.84 to 0.99 for MACE]) and in-hospital mortality (HR: 0.61; 95% CI: 0.55 to 0.67]) were less. The risk–benefit analyses suggested that statin treatment was favorable in high-risk (HR: 0.89; 95% CI: 0.83 to 0.95) and secondary prevention (HR: 0.89; 95% CI: 0.83 to 0.96) populations. Among diabetic patients, prior statin use was associated with fewer MACE (HR: 0.75; 95% CI: 0.59 to 0.97). In-hospital deaths were similar in statin-related diabetes among high-risk (HR: 1.11; 95% CI: 0.83 to 1.49) and secondary prevention (HR: 1.08; 95% CI: 0.79 to 1.47) subjects compared with nondiabetic controls.
Risk of diabetes was increased after statins, but outcomes were favorable. |
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| AbstractList | This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population.OBJECTIVESThis study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population.Cardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occurrence according to clinical trial analyses. From daily-practice perspectives, it remains unclear whether statin use increases risk; prognoses of diabetes after exposure require further clarification.BACKGROUNDCardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occurrence according to clinical trial analyses. From daily-practice perspectives, it remains unclear whether statin use increases risk; prognoses of diabetes after exposure require further clarification.From Taiwan National Health Insurance beneficiaries age ≥45 years (men) and ≥55 years (women) before 2004, subjects continuously treated with statins ≥30 days during 2000 to 2003 and nonusers before 2004 were identified. Among nondiabetic individuals at the cohort entry, controls were matched to statin users on a 4:1 ratio by age, sex, atherosclerotic comorbidities, and year of their entry. Outcomes as diabetes, major adverse cardiovascular events (MACE, the composite of myocardial infarction and ischemic stroke), and in-hospital deaths were assessed.METHODSFrom Taiwan National Health Insurance beneficiaries age ≥45 years (men) and ≥55 years (women) before 2004, subjects continuously treated with statins ≥30 days during 2000 to 2003 and nonusers before 2004 were identified. Among nondiabetic individuals at the cohort entry, controls were matched to statin users on a 4:1 ratio by age, sex, atherosclerotic comorbidities, and year of their entry. Outcomes as diabetes, major adverse cardiovascular events (MACE, the composite of myocardial infarction and ischemic stroke), and in-hospital deaths were assessed.Over a median of 7.2 years, annual rates of diabetes were significantly higher in statin users (2.4% vs. 2.1%, p < 0.001), whereas MACE (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.68 to 0.98 for myocardial infarction; HR: 0.94; 95% CI: 0.86 to 1.03 for ischemic stroke; HR: 0.91; 95% CI: 0.84 to 0.99 for MACE]) and in-hospital mortality (HR: 0.61; 95% CI: 0.55 to 0.67]) were less. The risk-benefit analyses suggested that statin treatment was favorable in high-risk (HR: 0.89; 95% CI: 0.83 to 0.95) and secondary prevention (HR: 0.89; 95% CI: 0.83 to 0.96) populations. Among diabetic patients, prior statin use was associated with fewer MACE (HR: 0.75; 95% CI: 0.59 to 0.97). In-hospital deaths were similar in statin-related diabetes among high-risk (HR: 1.11; 95% CI: 0.83 to 1.49) and secondary prevention (HR: 1.08; 95% CI: 0.79 to 1.47) subjects compared with nondiabetic controls.RESULTSOver a median of 7.2 years, annual rates of diabetes were significantly higher in statin users (2.4% vs. 2.1%, p < 0.001), whereas MACE (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.68 to 0.98 for myocardial infarction; HR: 0.94; 95% CI: 0.86 to 1.03 for ischemic stroke; HR: 0.91; 95% CI: 0.84 to 0.99 for MACE]) and in-hospital mortality (HR: 0.61; 95% CI: 0.55 to 0.67]) were less. The risk-benefit analyses suggested that statin treatment was favorable in high-risk (HR: 0.89; 95% CI: 0.83 to 0.95) and secondary prevention (HR: 0.89; 95% CI: 0.83 to 0.96) populations. Among diabetic patients, prior statin use was associated with fewer MACE (HR: 0.75; 95% CI: 0.59 to 0.97). In-hospital deaths were similar in statin-related diabetes among high-risk (HR: 1.11; 95% CI: 0.83 to 1.49) and secondary prevention (HR: 1.08; 95% CI: 0.79 to 1.47) subjects compared with nondiabetic controls.Risk of diabetes was increased after statins, but outcomes were favorable.CONCLUSIONSRisk of diabetes was increased after statins, but outcomes were favorable. ObjectivesThis study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population. BackgroundCardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occurrence according to clinical trial analyses. From daily-practice perspectives, it remains unclear whether statin use increases risk; prognoses of diabetes after exposure require further clarification. MethodsFrom Taiwan National Health Insurance beneficiaries age ≥45 years (men) and ≥55 years (women) before 2004, subjects continuously treated with statins ≥30 days during 2000 to 2003 and nonusers before 2004 were identified. Among nondiabetic individuals at the cohort entry, controls were matched to statin users on a 4:1 ratio by age, sex, atherosclerotic comorbidities, and year of their entry. Outcomes as diabetes, major adverse cardiovascular events (MACE, the composite of myocardial infarction and ischemic stroke), and in-hospital deaths were assessed. ResultsOver a median of 7.2 years, annual rates of diabetes were significantly higher in statin users (2.4% vs. 2.1%, p < 0.001), whereas MACE (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.68 to 0.98 for myocardial infarction; HR: 0.94; 95% CI: 0.86 to 1.03 for ischemic stroke; HR: 0.91; 95% CI: 0.84 to 0.99 for MACE]) and in-hospital mortality (HR: 0.61; 95% CI: 0.55 to 0.67]) were less. The risk–benefit analyses suggested that statin treatment was favorable in high-risk (HR: 0.89; 95% CI: 0.83 to 0.95) and secondary prevention (HR: 0.89; 95% CI: 0.83 to 0.96) populations. Among diabetic patients, prior statin use was associated with fewer MACE (HR: 0.75; 95% CI: 0.59 to 0.97). In-hospital deaths were similar in statin-related diabetes among high-risk (HR: 1.11; 95% CI: 0.83 to 1.49) and secondary prevention (HR: 1.08; 95% CI: 0.79 to 1.47) subjects compared with nondiabetic controls. ConclusionsRisk of diabetes was increased after statins, but outcomes were favorable. This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population. Cardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occurrence according to clinical trial analyses. From daily-practice perspectives, it remains unclear whether statin use increases risk; prognoses of diabetes after exposure require further clarification. From Taiwan National Health Insurance beneficiaries age ≥45 years (men) and ≥55 years (women) before 2004, subjects continuously treated with statins ≥30 days during 2000 to 2003 and nonusers before 2004 were identified. Among nondiabetic individuals at the cohort entry, controls were matched to statin users on a 4:1 ratio by age, sex, atherosclerotic comorbidities, and year of their entry. Outcomes as diabetes, major adverse cardiovascular events (MACE, the composite of myocardial infarction and ischemic stroke), and in-hospital deaths were assessed. Over a median of 7.2 years, annual rates of diabetes were significantly higher in statin users (2.4% vs. 2.1%, p < 0.001), whereas MACE (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.68 to 0.98 for myocardial infarction; HR: 0.94; 95% CI: 0.86 to 1.03 for ischemic stroke; HR: 0.91; 95% CI: 0.84 to 0.99 for MACE]) and in-hospital mortality (HR: 0.61; 95% CI: 0.55 to 0.67]) were less. The risk–benefit analyses suggested that statin treatment was favorable in high-risk (HR: 0.89; 95% CI: 0.83 to 0.95) and secondary prevention (HR: 0.89; 95% CI: 0.83 to 0.96) populations. Among diabetic patients, prior statin use was associated with fewer MACE (HR: 0.75; 95% CI: 0.59 to 0.97). In-hospital deaths were similar in statin-related diabetes among high-risk (HR: 1.11; 95% CI: 0.83 to 1.49) and secondary prevention (HR: 1.08; 95% CI: 0.79 to 1.47) subjects compared with nondiabetic controls. Risk of diabetes was increased after statins, but outcomes were favorable. Objectives This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population. Background Cardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occurrence according to clinical trial analyses. From daily-practice perspectives, it remains unclear whether statin use increases risk; prognoses of diabetes after exposure require further clarification. Methods From Taiwan National Health Insurance beneficiaries age >=45 years (men) and >=55 years (women) before 2004, subjects continuously treated with statins >=30 days during 2000 to 2003 and nonusers before 2004 were identified. Among nondiabetic individuals at the cohort entry, controls were matched to statin users on a 4:1 ratio by age, sex, atherosclerotic comorbidities, and year of their entry. Outcomes as diabetes, major adverse cardiovascular events (MACE, the composite of myocardial infarction and ischemic stroke), and in-hospital deaths were assessed. Results Over a median of 7.2 years, annual rates of diabetes were significantly higher in statin users (2.4% vs. 2.1%, p < 0.001), whereas MACE (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.68 to 0.98 for myocardial infarction; HR: 0.94; 95% CI: 0.86 to 1.03 for ischemic stroke; HR: 0.91; 95% CI: 0.84 to 0.99 for MACE]) and in-hospital mortality (HR: 0.61; 95% CI: 0.55 to 0.67]) were less. The risk-benefit analyses suggested that statin treatment was favorable in high-risk (HR: 0.89; 95% CI: 0.83 to 0.95) and secondary prevention (HR: 0.89; 95% CI: 0.83 to 0.96) populations. Among diabetic patients, prior statin use was associated with fewer MACE (HR: 0.75; 95% CI: 0.59 to 0.97). In-hospital deaths were similar in statin-related diabetes among high-risk (HR: 1.11; 95% CI: 0.83 to 1.49) and secondary prevention (HR: 1.08; 95% CI: 0.79 to 1.47) subjects compared with nondiabetic controls. Conclusions Risk of diabetes was increased after statins, but outcomes were favorable. |
| Author | Chao, Tze-Fan Wu, Cheng-Hsueh Wang, Kang-Ling Chen, Tzeng-Ji Chiang, Chern-En Liu, Chia-Jen Chen, Su-Jung Huang, Chi-Ming Lin, Shing-Jong |
| Author_xml | – sequence: 1 givenname: Kang-Ling surname: Wang fullname: Wang, Kang-Ling organization: Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan – sequence: 2 givenname: Chia-Jen surname: Liu fullname: Liu, Chia-Jen organization: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan – sequence: 3 givenname: Tze-Fan surname: Chao fullname: Chao, Tze-Fan organization: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan – sequence: 4 givenname: Chi-Ming surname: Huang fullname: Huang, Chi-Ming organization: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan – sequence: 5 givenname: Cheng-Hsueh surname: Wu fullname: Wu, Cheng-Hsueh organization: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan – sequence: 6 givenname: Su-Jung surname: Chen fullname: Chen, Su-Jung organization: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan – sequence: 7 givenname: Tzeng-Ji surname: Chen fullname: Chen, Tzeng-Ji organization: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan – sequence: 8 givenname: Shing-Jong surname: Lin fullname: Lin, Shing-Jong organization: Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan – sequence: 9 givenname: Chern-En surname: Chiang fullname: Chiang, Chern-En email: cechiang@vghtpe.gov.tw organization: Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan |
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| Copyright | 2012 American College of Cardiology Foundation American College of Cardiology Foundation 2014 INIST-CNRS Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. Copyright Elsevier Limited Oct 2, 2012 |
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| Keywords | ICD-9 CV MACE statins CI HR outcome research MI NHIRD diabetes CHD NHI myocardial infarction major adverse cardiovascular event(s) cardiovascular National Health Insurance Research Database hazard ratio coronary heart disease confidence interval National Health Insurance International Classification of Diseases-Ninth Revision Endocrinopathy Prognosis Diabetes mellitus Risk factor Population Risk Statin derivative Circulatory system Cardiology |
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10.1016/j.jacc.2010.03.062 – reference: 23449434 - J Am Coll Cardiol. 2013 Mar 5;61(9):989 – reference: 22922594 - Nat Rev Cardiol. 2012 Oct;9(10):552 – reference: 23449435 - J Am Coll Cardiol. 2013 Mar 5;61(9):989-90 |
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| Snippet | This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population.
Cardiovascular events... ObjectivesThis study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population.... Objectives This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population. Background... This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population.OBJECTIVESThis study... |
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| SubjectTerms | Aged Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Case-Control Studies Cholesterol Cohort Studies Coronary Disease - drug therapy Coronary Disease - prevention & control diabetes Diabetes Mellitus - chemically induced Diabetes Mellitus - epidemiology Diabetes. Impaired glucose tolerance Drug therapy Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female Follow-Up Studies Heart attacks Hospital Mortality Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hypertension - drug therapy Incidence Longitudinal Studies Male Medical research Medical sciences Middle Aged Myocardial Infarction - epidemiology Myocardial Infarction - etiology outcome research Retrospective Studies Risk Assessment Statins Stroke - epidemiology Stroke - etiology Studies Treatment Outcome |
| Title | Statins, Risk of Diabetes, and Implications on Outcomes in the General Population |
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