Risk of New-Onset Diabetes Mellitus Versus Reduction in Cardiovascular Events With Statin Therapy

• Published in: The American journal of cardiology 2014-02, Vol.113 (4), p.631-636
• Main Authors: Wang, Kang-Ling, MD, Liu, Chia-Jen, MD, Chao, Tze-Fan, MD, Chen, Su-Jung, MD, Wu, Cheng-Hsueh, MD, Huang, Chi-Ming, MD, Chang, Chun-Chin, MD, Wang, Ko-Fan, MD, Chen, Tzeng-Ji, MD, PhD, Lin, Shing-Jong, MD, PhD, Chiang, Chern-En, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - mortality; Cholesterol; Diabetes; Diabetes Mellitus - chemically induced; Drug therapy; Female; Follow-Up Studies; Heart attacks; Hospitalization - statistics & numerical data; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Incidence; Male; Middle Aged; Propensity Score; Risk Assessment; Statins; Survival Analysis
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.10.043

The Food and Drug Administration recently updated the safety warning concerning the association between statin therapy and new-onset diabetes mellitus (NODM). For prediabetes, little information is available for statins on cardiovascular outcome reduction and diabetogenic consequences. This study aimed to examine the risk of NODM and the reduction of cardiovascular events and death (MACE) after statin therapy in the prediabetic subjects. The medical and pharmacy claims of the prediabetic beneficiaries were retrieved from Taiwan National Health Insurance research database. The occurrence of NODM, MACE, and morbidity indexed by hospitalizations and emergency visits was ascertained by ambulatory and inpatient database. A propensity score–matched model was constructed for statin users and nonusers. During follow-up (4.1 ± 2.5 years), NODM and MACE occurred in 23.5% and 16.7%, respectively, of nonusers and 28.5% and 12.0%, respectively, of users. Statin therapy was associated with a greater risk of NODM (hazard ratio 1.20, 95% confidence interval 1.08 to 1.32) and less risk of MACE (hazard ratio 0.70, 95% confidence interval 0.61 to 0.80), both in dose-dependent fashions. The earlier and more persistent use correlated with the greater increase in risk of NODM offset by the proportionally larger reduction in MACE. Furthermore, the early persistent users had the lowest rate of hospitalizations and emergency visits. In conclusion, our findings suggested that the relation between NODM and therapeutic advantages of statins was parallel in the prediabetic population. Treatment benefits outweighed diabetic consequences in subjects receiving the earlier and more persistent treatment.