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Statins and risk for new-onset diabetes mellitus

View Article: PubMed Central - PubMed

ABSTRACT

Although concern regarding the increased risk for new-onset diabetes mellitus (NODM) after statin treatment has been raised, there has been a lack of evidence in real-world clinical practice, particularly in East Asians. We investigated whether statin use is associated with risk for NODM in Koreans. We conducted a retrospective cohort study using the clinical research database from electronic health records. The study cohort consisted of 8265 statin-exposed and 33,060 matched nonexposed patients between January 1996 and August 2013. Matching at a 1:4 ratio was performed using a propensity score based on age, gender, baseline glucose levels (mg/dL), and hypertension. The comparative risks for NODM with various statins (atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin) were estimated by both statin exposure versus matched nonexposed and within-class comparisons. The incidence of NODM among the statin-exposed group (6.000 per 1000 patient-years [PY]) was higher than that of the nonexposed group (3.244 per 1000 PY). The hazard ratio (HR) of NODM after statin exposure was 1.872 (95% confidence interval [CI], 1.432–2.445). Male gender (HR, 1.944; 95% CI, 1.497–2.523), baseline glucose per mg/dL (HR, 1.014; 95% CI, 1.013–1.016), hypertension (HR, 2.232; 95% CI, 1.515–3.288), and thiazide use (HR, 1.337; 95% CI, 1.081–1.655) showed an increased risk for NODM, while angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker showed a decreased risk (HR, 0.774; 95% CI, 0.668–0.897). Atorvastatin-exposed patients showed a higher risk for NODM than their matched nonexposed counterparts (HR, 1.939; 95% CI, 1.278–2.943). However, the risk for NODM was not significantly different among statins in within-class comparisons. In conclusion, an increased risk for NODM was observed among statin users in a practical healthcare setting in Korea.

No MeSH data available.


Related in: MedlinePlus

Overview of the study design. To evaluate the risk for new-onset diabetes mellitus (NODM) after exposure to statins, statin-exposed patients were compared to matched nonexposed patients (comparison 1). To evaluate the risks associated with 6 different statins (atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin), comparison 2 (comparison between patients exposed to each statin and the matched nonexposed patients) and comparison 3 (within-class analysis) were conducted.
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Figure 1: Overview of the study design. To evaluate the risk for new-onset diabetes mellitus (NODM) after exposure to statins, statin-exposed patients were compared to matched nonexposed patients (comparison 1). To evaluate the risks associated with 6 different statins (atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin), comparison 2 (comparison between patients exposed to each statin and the matched nonexposed patients) and comparison 3 (within-class analysis) were conducted.

Mentions: The study cohort consisted of statin-exposed patients and nonexposed patients who were 18 years of age or older in the subject hospital (Fig. 1). Statin-exposed patients were patients exposed to statins for more than 90 consecutive days. Continuous exposure was defined as follows: if repeated prescription of the drug was followed within a 30-day window, 2 prescriptions were considered continuous administration. For the selection of nonexposed patients, those followed up for more than 90 days and not exposed to any statins were selected. The exposure patients were divided into 6 subgroups according to the type of statin: atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. Each subgroup included patients who took each statin continuously for more than 90 days. To include only incident users, when a patient had more than 2 continuous administration periods, only the first one was included in the study. Patients with a proportion of days covering <60% were excluded. Patients who had a psychiatric disorder or received organ transplant(s) were excluded due to the established high risk for NODM in these groups.


Statins and risk for new-onset diabetes mellitus
Overview of the study design. To evaluate the risk for new-onset diabetes mellitus (NODM) after exposure to statins, statin-exposed patients were compared to matched nonexposed patients (comparison 1). To evaluate the risks associated with 6 different statins (atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin), comparison 2 (comparison between patients exposed to each statin and the matched nonexposed patients) and comparison 3 (within-class analysis) were conducted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120943&req=5

Figure 1: Overview of the study design. To evaluate the risk for new-onset diabetes mellitus (NODM) after exposure to statins, statin-exposed patients were compared to matched nonexposed patients (comparison 1). To evaluate the risks associated with 6 different statins (atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin), comparison 2 (comparison between patients exposed to each statin and the matched nonexposed patients) and comparison 3 (within-class analysis) were conducted.
Mentions: The study cohort consisted of statin-exposed patients and nonexposed patients who were 18 years of age or older in the subject hospital (Fig. 1). Statin-exposed patients were patients exposed to statins for more than 90 consecutive days. Continuous exposure was defined as follows: if repeated prescription of the drug was followed within a 30-day window, 2 prescriptions were considered continuous administration. For the selection of nonexposed patients, those followed up for more than 90 days and not exposed to any statins were selected. The exposure patients were divided into 6 subgroups according to the type of statin: atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. Each subgroup included patients who took each statin continuously for more than 90 days. To include only incident users, when a patient had more than 2 continuous administration periods, only the first one was included in the study. Patients with a proportion of days covering <60% were excluded. Patients who had a psychiatric disorder or received organ transplant(s) were excluded due to the established high risk for NODM in these groups.

View Article: PubMed Central - PubMed

ABSTRACT

Although concern regarding the increased risk for new-onset diabetes mellitus (NODM) after statin treatment has been raised, there has been a lack of evidence in real-world clinical practice, particularly in East Asians. We investigated whether statin use is associated with risk for NODM in Koreans. We conducted a retrospective cohort study using the clinical research database from electronic health records. The study cohort consisted of 8265 statin-exposed and 33,060 matched nonexposed patients between January 1996 and August 2013. Matching at a 1:4 ratio was performed using a propensity score based on age, gender, baseline glucose levels (mg/dL), and hypertension. The comparative risks for NODM with various statins (atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin) were estimated by both statin exposure versus matched nonexposed and within-class comparisons. The incidence of NODM among the statin-exposed group (6.000 per 1000 patient-years [PY]) was higher than that of the nonexposed group (3.244 per 1000 PY). The hazard ratio (HR) of NODM after statin exposure was 1.872 (95% confidence interval [CI], 1.432&ndash;2.445). Male gender (HR, 1.944; 95% CI, 1.497&ndash;2.523), baseline glucose per mg/dL (HR, 1.014; 95% CI, 1.013&ndash;1.016), hypertension (HR, 2.232; 95% CI, 1.515&ndash;3.288), and thiazide use (HR, 1.337; 95% CI, 1.081&ndash;1.655) showed an increased risk for NODM, while angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker showed a decreased risk (HR, 0.774; 95% CI, 0.668&ndash;0.897). Atorvastatin-exposed patients showed a higher risk for NODM than their matched nonexposed counterparts (HR, 1.939; 95% CI, 1.278&ndash;2.943). However, the risk for NODM was not significantly different among statins in within-class comparisons. In conclusion, an increased risk for NODM was observed among statin users in a practical healthcare setting in Korea.

No MeSH data available.


Related in: MedlinePlus