Use of Statins and the Risk of Incident Diabetes: A Retrospective Cohort Study.
BACKGROUND
Even though several landmark statin trials have demonstrated the beneficial effects of statin therapy in both primary and secondary prevention of cardiovascular disease, several studies have suggested that statins are associated with a moderate increase in risk of new-onset diabetes. These observations prompted the US FDA to revise statin labels to include a warning of an increased risk of incident diabetes mellitus as a result of increases in glycosylated hemoglobin (HbA1c) and fasting plasma glucose. However, few studies have used US-based data to investigate this statin-associated increased risk of diabetes.


OBJECTIVE
The primary objective of our study was to examine whether the use of statins increases the risk of incident diabetes mellitus using data from the Thomson Reuters MarketScan (®) Commercial Claims and Encounters Database.


METHODS
This study was a retrospective cohort analysis utilizing data for the period 2003-2004. The study population included new statin users aged 20-63 years at index who did not have a history of diabetes.


RESULTS
The proportion (3.4 %) of statin users (N = 53,212) who had incident diabetes was higher than the proportion (1.2 %) of non-statin users (N = 53,212) who had incident diabetes. Compared with no statin use and controlling for demographic and clinical covariates, statin use was significantly associated with increased risk of incident diabetes (hazard ratio 2.01; 99 % confidence interval 1.74-2.33; p < 0.0001). In addition, risk of diabetes was highest among users of lovastatin, atorvastatin, simvastatin, and fluvastatin. Diabetes risk was lowest among pravastatin and rosuvastatin users.


CONCLUSIONS
Because the potential for diabetogenicity differs among different statin types, healthcare professionals should individualize statin therapy by identifying patients who would benefit more from less diabetogenic statin types.
Department of Pharmacy Practice, University of Kansas School of Pharmacy, 2010 Becker Dr., Lawrence, KS, 66047, USA. buzzlotus@ku.edu.|Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue A1930, Austin, TX, 78712-1120, USA. buzzlotus@ku.edu.|Austin Outcomes Research, 1600 Flintridge Rd, West Lake Hills, TX, 78746, USA. buzzlotus@ku.edu.
Busuyi S
BS
Olotu
Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue A1930, Austin, TX, 78712-1120, USA.
Marvin D
MD
Shepherd
Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue A1930, Austin, TX, 78712-1120, USA.|Austin Outcomes Research, 1600 Flintridge Rd, West Lake Hills, TX, 78746, USA.
Suzanne
S
Novak
Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue A1930, Austin, TX, 78712-1120, USA.
Kenneth A
KA
Lawson
Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue A1930, Austin, TX, 78712-1120, USA.
James P
JP
Wilson
Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue A1930, Austin, TX, 78712-1120, USA.
Kristin M
KM
Richards
Department of Pharmacy Practice, University of Kansas School of Pharmacy, 2010 Becker Dr., Lawrence, KS, 66047, USA.
Rafia S
RS
Rasu
D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000378:metabolism; D003920:Diabetes Mellitus / Q000139:chemically induced* / Q000209:etiology* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors