title: The effect of diabetes, hyperlipidemia, and statins on the development of rotator cuff disease: a nationwide, 11-year, longitudinal, population-based follow-up study.
abstract: BACKGROUND
  The intrinsic risk factors of rotator cuff disease (RCD) include degeneration, inflammation, oxidative stress, and circulation impairment. Both diabetes and hyperlipidemia are thought to increase these risk factors and therefore potentially enhance RCD development. However, few studies, and few longitudinal follow-up studies in particular, exist to prove this.
  
  
  OBJECTIVE
  Both diabetes and hyperlipidemia can increase a patient's risk of developing RCD.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A total of 498,678 participants, including 28,391 diagnosed with diabetes and 25,621 with hyperlipidemia in the year 2000, were followed for an 11-year period. Multivariate Cox proportional hazards models were used to explore the effect of (1) diabetes, (2) hyperlipidemia, (3) diabetes with/without insulin use, and (4) hyperlipidemia with/without statin use on the development of RCD. In the subgroup of patients with hyperlipidemia, multivariate Cox proportional hazards models were also performed to explore the relationship between statin use and RCD development.
  
  
  RESULTS
  During an 11-year follow-up period, 26,664 patients developed RCD. The crude hazard ratio (HR) for RCD in patients with diabetes as compared with those without diabetes was 2.11 (95% CI, 2.02-2.20; P < .0001). The crude HR for RCD in patients with hyperlipidemia as compared with those without hyperlipidemia was 2.00 (95% CI, 1.92-2.08; P < .0001). Multivariate Cox proportional hazards analysis revealed that, in addition to older age and female sex, both diabetes and hyperlipidemia increased the risk of RCD (diabetes: HR, 1.47 [95% CI, 1.41-1.54]; P < .0001) (hyperlipidemia: HR, 1.48 [95% CI, 1.42-1.55]; P < .0001). An elevated risk still existed in patients with diabetes with/without insulin use (diabetes with insulin use: HR, 1.43 [95% CI, 1.35-1.51]; P < .0001) (diabetes without insulin use: HR, 1.64 [95% CI, 1.53-1.75]; P < .0001). An increased risk also existed in patients with hyperlipidemia with/without statin use (hyperlipidemia with statin use: HR, 1.16 [95% CI, 1.10-1.23]; P < .0001) (hyperlipidemia without statin use: HR, 2.01 [95% CI, 1.89-2.13]; P < .0001). In the subgroup of patients with hyperlipidemia, statin use was associated with a lower risk of developing RCD when compared with no statin use (rosuvastatin: HR, 0.41 [95% CI, 0.35-0.49]; P < .0001) (simvastatin: HR, 0.62 [95% CI, 0.54-0.71]; P < .0001) (other statins: HR, 0.66 [95% CI, 0.60-0.72]; P < .0001).
  
  
  CONCLUSIONS
  The present longitudinal, population-based follow-up study showed that either diabetes or hyperlipidemia alone was an independent risk factor for RCD development. Statin use might provide protection against RCD in patients with hyperlipidemia.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan Department of Statistics, Feng Chia University, Taichung, Taiwan.
authors.forename: Tony Tung-Liang
authors.initials: TT
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Ching-Heng
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chia-Li
authors.initials: CL
authors.lastname: Chang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chun-Han
authors.initials: CH
authors.lastname: Chi
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Shin-Tsu
authors.initials: ST
authors.lastname: Chang
authors.affiliation: School of Medicine, National Defense Medical Center, Taipei, Taiwan Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan School of Medicine, National Yang-Ming University, Taipei, Taiwan Institute of Medical Technology, National Chung-Hsing University, Taichung, Taiwan whhsheu@vghtc.gov.tw.
authors.forename: Wayne Huey-Herng
authors.initials: WH
authors.lastname: Sheu
mesh_terms: D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000150:complications*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects*; D006949:Hyperlipidemias / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000209:etiology*; D000068718:Rosuvastatin Calcium; D017006:Rotator Cuff
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium
keywords: diabetes; hyperlipidemia; rotator cuff; shoulder; statin