The online version of this article (doi:10.1186/1471-2261-14-85) contains supplementary material, which is available to authorized users.
AFM, HF and SE have no relevant interests to declare. LS has undertaken advisory work for GSK. ID holds stock in and consults for GSK, and consults for Gilead.
SE origination of idea and control of content. All authors were involved in the design of the study and contributed to interpretation of results and drafting of the first submission. AFM carried out the main data management and statistical analysis, with the help of ID and HF. All authors read and approved the final manuscript.
There is strong evidence of reductions in major vascular events from statins across all cardiovascular risk categories. However, trials of statin therapy have provided conflicting results regarding statin use and type 2 diabetes (T2DM). We aimed to assess the effect of statins on T2DM development.
We carried out a population-based cohort study using the Clinical Practice Research Datalink (CPRD), a database of computerized clinical records. Every patient aged 30–85 years old starting a statin between 1989 and 2009 was matched with up to five non-statin users. The observation period in CPRD ended in 31 December 2011. Cox proportional hazard regression was used to compare rates of T2DM between statin users and non-users, using propensity score method to adjust for systematic differences between groups.
The study basis comprised 2,016,094 individuals, including 430,890 people who received a statin, matched to 1,585,204 people not prescribed a statin. Mean follow-up time was 5.43 years for statin users and 3.89 years for nonusers. During follow-up 130,395 individuals developed T2DM. Statin use was associated with an increased risk of T2DM (HR 1.57; 95% CI 1.54-1.59), which increases with longer duration of use. The increased risk was smaller among people with hypertension or cardiovascular disease and was only apparent after 5 or more years treatment with statins in these groups. Conversely, age-specific risk ratios decreased in older people.
Statin use is associated with an increased risk of T2DM. Our results suggest that the relative risk is higher among people without diagnosed hypertension or cardiovascular disease. These findings should be considered in the context of the observational nature of the data which is prone to bias and unmeasured confounding.
Additional file 1: List S1- Read codes for type 2 diabetes. Table S1. Sensitivity analysis censoring observation periods at time of stopping or changing therapy. Table S2. Baseline characteristics (%) of hypertensive and CVD patients, according to exposure status. Table S3. Incident rates of T2DM at different follow-up times, according to hypertension and CVD diagnosis, for individuals with BMI ≤ 25Kg/m2. (DOC 362 KB)
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- Statins and the risk of type 2 diabetes mellitus: cohort study using the UK clinical practice pesearch datalink
Ana Filipa Macedo
- BioMed Central
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