title: Statins, risk of diabetes, and implications on outcomes in the general population.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Kang-Ling
authors.initials: KL
authors.lastname: Wang
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Tze-Fan
authors.initials: TF
authors.lastname: Chao
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Huang
authors.forename: Cheng-Hsueh
authors.initials: CH
authors.lastname: Wu
authors.forename: Su-Jung
authors.initials: SJ
authors.lastname: Chen
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.forename: Chern-En
authors.initials: CE
authors.lastname: Chiang
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000139:chemically induced* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors