title: Impact of incident diabetes on atherosclerotic cardiovascular disease according to statin use history among postmenopausal women.
abstract: To compare impact of incident diabetes on atherosclerotic cardiovascular disease (ASCVD) risk among postmenopausal women according to statin use. Prospective data from 120,499 postmenopausal women without prevalent diabetes or cardiovascular disease at baseline from the Women's Health Initiative were used. Incident diabetes was self-reported annually and defined as treatment with pills or injectable medication for diabetes. Current statin use was determined at enrollment and years 1, 3, 6, 9 and 13.5 in the three clinical trial arms, and at baseline, year 3, and 13.5 for the observational study. The primary outcome was incident ASCVD events, self-reported annually and adjudicated by blinded local and central physicians. Incident diabetes and statin use status were fitted as time-varying covariates in Cox regression models to assess ASCVD risk during an average follow-up of 13.6 years. For those not on statins at the time of diabetes diagnosis, there was a 42 % increased risk of ASCVD [hazard ratio (HR) 1.42, 95 % CI 1.28-1.58] among women with incident diabetes versus those without diabetes. Among women on statins, there was a 39 % increased risk of ASCVD (HR 1.39, 95 % CI 1.12-1.74) in women with incident diabetes versus those without diabetes. The increased ASCVD risk due to diabetes was similar between women before or after initiating statins (P = 0.89). Whether diabetes was diagnosed before or after statin use did not alter the increased risk of ASCVD associated with diabetes. Mitigating the increased incidence of diabetes in statin users could increase the ASCVD benefit-to-risk ratio of statins.
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. Yunsheng.Ma@umassmed.edu.
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Corrona LLC, 352 Boston Turnpike, Southborough, MA, 01772, USA.
authors.forename: Gioia M
authors.initials: GM
authors.lastname: Persuitte
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, 48105, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Andrews
authors.affiliation: Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY, 14214, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Hovey
authors.affiliation: Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY, 14214, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaMonte
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Annie L
authors.initials: AL
authors.lastname: Culver
authors.affiliation: Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.affiliation: Division of Endocrinology, Emory University, Atlanta, GA, 30322, USA.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.affiliation: School of Public Health, Brown University, Providence, RI, 02903, USA.
authors.forename: Simin
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Family Medicine, School of Medicine, Brown University, Providence, RI, 02912, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Eaton
authors.affiliation: Division of Cardiology, School of Medicine and Health Sciences, George Washington University, Washington, DC, 20037, USA.
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Martin
authors.affiliation: MedStar Research Institute, Hyattsville, MD, 20782, USA.
authors.forename: Barbara V
authors.initials: BV
authors.lastname: Howard
authors.affiliation: Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA.
authors.forename: Raji
authors.initials: R
authors.lastname: Balasubramanian
authors.affiliation: RAND Corporation, Santa Monica, CA, 90407, USA.
authors.forename: Chloe E
authors.initials: CE
authors.lastname: Bird
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
authors.forename: Ira S
authors.initials: IS
authors.lastname: Ockene
authors.affiliation: Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Sturgeon
authors.affiliation: Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
authors.forename: Judith K
authors.initials: JK
authors.lastname: Ockene
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
authors.forename: Lesley
authors.initials: L
authors.lastname: Tinker
authors.affiliation: Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, CA, 95616, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Nassir
authors.affiliation: Women's Health Initiative Branch, National Heart, Lung, and Blood Institute, Bethesda, MD, 20892, USA.
authors.forename: Jacques
authors.initials: J
authors.lastname: Rossouw
mesh_terms: D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008875:Middle Aged; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular disease; Diabetes; Drug-related problem; Epidemiology