title: Statins and the risk of diabetes: evidence from a large population-based cohort study.
abstract: OBJECTIVE
  To investigate the relationship between adherence with statin therapy and the risk of developing diabetes.
  
  
  METHODS
  The cohort comprised 115,709 residents of the Italian Lombardy region who were newly treated with statins during 2003 and 2004. Patients were followed from the index prescription until 2010. During this period, patients who began therapy with an antidiabetic agent or were hospitalized for a main diagnosis of type 2 diabetes were identified (outcome). Adherence was measured by the proportion of days covered (PDC) with statins (exposure). A proportional hazards model was fitted to estimate hazard ratios (HRs) and 95% CIs for the exposure-outcome association, after adjusting for several covariates. A set of sensitivity analyses was performed to account for sources of systematic uncertainty.
  
  
  RESULTS
  During follow-up, 11,154 cohort members experienced the outcome. Compared with patients with very-low adherence (PDC <25%), those with low (26-50%), intermediate (51-75%), and high (≥75%) adherence to statin therapy had HRs (95% CIs) of 1.12 (1.06-1.18), 1.22 (1.14-1.27), and 1.32 (1.26-1.39), respectively.
  
  
  CONCLUSIONS
  In a real-world setting, the risk of new-onset diabetes rises as adherence with statin therapy increases. Benefits of statins in reducing cardiovascular events clearly overwhelm the diabetes risk.
authors: Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy giovanni.corrao@unimib.it.
authors: Giovanni
authors: G
authors: Corrao
authors: Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
authors: Buthaina
authors: B
authors: Ibrahim
authors: Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
authors: Federica
authors: F
authors: Nicotra
authors: Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
authors: Davide
authors: D
authors: Soranna
authors: Operative Unit of Territorial Health Services, Region Lombardia, Milan, Italy.
authors: Luca
authors: L
authors: Merlino
authors: Department of Pharmacological and Biomolecular Sciences, Centre of Epidemiology and Preventive Pharmacology (SEFAP), University of Milano, Milan, ItalyIRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors: Alberico L
authors: AL
authors: Catapano
authors: Department of Pharmacological and Biomolecular Sciences, Centre of Epidemiology and Preventive Pharmacology (SEFAP), University of Milano, Milan, Italy.
authors: Elena
authors: E
authors: Tragni
authors: Department of Pharmacological and Biomolecular Sciences, Centre of Epidemiology and Preventive Pharmacology (SEFAP), University of Milano, Milan, Italy.
authors: Manuela
authors: M
authors: Casula
authors: IRCCS Multimedica, Sesto San Giovanni, Milan, ItalyDepartment of Health Science, University of Milano-Bicocca, Milan, Italy.
authors: Guido
authors: G
authors: Grassi
authors: Department of Health Science, University of Milano-Bicocca, Milan, ItalyIRCCS Istituto Auxologico Italiano, Milan, Italy.
authors: Giuseppe
authors: G
authors: Mancia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016903:Drug Monitoring
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors