title: Higher potency statins and the risk of new diabetes: multicentre, observational study of administrative databases.
abstract: OBJECTIVE
  To evaluate the incremental increase in new onset diabetes from higher potency statins compared with lower potency statins when used for secondary prevention.
  
  
  METHODS
  Eight population based cohort studies and a meta-analysis.
  
  
  METHODS
  Six Canadian provinces and two international databases from the UK and US.
  
  
  METHODS
  136,966 patients aged ≥ 40 years newly treated with statins between 1 January 1997 and 31 March 2011.
  
  
  METHODS
  Within each cohort of patients newly prescribed a statin after hospitalisation for a major cardiovascular event or procedure, we performed as-treated, nested case-control analyses to compare diabetes incidence in users of higher potency statins with incidence in users of lower potency statins. Rate ratios of new diabetes events were estimated using conditional logistic regression on different lengths of exposure to higher potency versus lower potency statins; adjustment for confounding was achieved using high dimensional propensity scores. Meta-analytic methods were used to estimate overall effects across sites.
  
  
  METHODS
  Hospitalisation for new onset diabetes, or a prescription for insulin or an oral antidiabetic drug.
  
  
  RESULTS
  In the first two years of regular statin use, we observed a significant increase in the risk of new onset diabetes with higher potency statins compared with lower potency agents (rate ratio 1.15, 95% confidence interval 1.05 to 1.26). The risk increase seemed to be highest in the first four months of use (rate ratio 1.26, 1.07 to 1.47).
  
  
  CONCLUSIONS
  Higher potency statin use is associated with a moderate increase in the risk of new onset diabetes compared with lower potency statins in patients treated for secondary prevention of cardiovascular disease. Clinicians should consider this risk when prescribing higher potency statins in secondary prevention patients.
authors.affiliation: Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Victoria, BC V8W 1Y2, Canada colin.dormuth@ti.ubc.ca.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Dormuth
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Kristian B
authors.initials: KB
authors.lastname: Filion
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
authors.affiliation: Health Quality Council, Saskatoon, Canada.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Teare
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada.
authors.forename: Colette B
authors.initials: CB
authors.lastname: Raymond
authors.affiliation: Department of Medicine, McGill University, Montreal, Canada.
authors.forename: Elham
authors.initials: E
authors.lastname: Rahme
authors.affiliation: School of Kinesiology and Health Science, York University, Toronto, Canada.
authors.forename: Hala
authors.initials: H
authors.lastname: Tamim
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lipscombe
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors