title: Diabetes mellitus and cardiovascular events in older patients with myocardial infarction prescribed intensive-dose and moderate-dose statins.
abstract: BACKGROUND
  Practice guidelines recommend intensive-dose statins for patients with acute coronary syndrome, but recent data about the risk of new-onset diabetes mellitus have raised concerns about its use. Our main objective was to evaluate the association between intensive statin therapy and new-onset diabetes mellitus in patients with myocardial infarction and to evaluate the association of intensive statin therapy with long-term adverse clinical outcomes.
  
  
  RESULTS
  A propensity score-matched cohort was created consisting of 17 080 patients with myocardial infarction aged >65 years old, hospitalized in Ontario, Canada, from 2004 to 2010. Clinical outcomes were compared in patients prescribed intensive-dose versus moderate-dose statins at hospital discharge. At 5 years, 13.6% of patients receiving intensive-dose statins and 13.0% of patients receiving moderate-dose statins had new-onset diabetes, which was not significantly different (P=0.19). By contrast, the 5-year rate of death or acute coronary syndrome was significantly lower at 44.8% in the intensive-dose statin group compared with 46.5% in the moderate-dose group (P=0.044). The reduction in combined clinical outcome was driven mainly by a significantly lower rate of acute coronary syndrome (P=0.039) associated with intensive-dose statins. No significant difference in mortality rates (34.8% in both groups) was observed between the treatment groups during the study period (P=0.89).
  
  
  CONCLUSIONS
  In older patients with myocardial infarction, we found intensive-dose statin therapy to be effective in reducing repeat hospitalization for acute coronary syndrome. The rate of new-onset diabetes mellitus at long term was not significantly different between intensive-dose and moderate-dose statins.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. dennis.ko@ices.on.ca
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Jackevicius
authors.forename: Altayyeb
authors.initials: A
authors.lastname: Yousef
authors.forename: Julie
authors.initials: J
authors.lastname: Wang
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D009864:Ontario / Q000453:epidemiology; D010351:Patient Discharge; D010359:Patient Readmission; D057216:Propensity Score; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: acute coronary syndrome; intensive-dose statins; new-onset diabetes mellitus