Higher potency statins and the risk of new diabetes: multicentre, observational study of administrative databases

Dormuth CR, Filion KB, Paterson JM, et al; for the Canadian Network for Observational Drug Effect Studies (CNODES) Investigators. Higher potency statins and the risk of new diabetes: multicentre, observational study of administrative databases. BMJ. 2014;348:g3244.

 
This observational study of multinational population-based cohort studies and a meta-analysis evaluated risk of new diabetes with higher- vs lower-potency statin use. Subjects (N=136,966) were aged ≥40 years, had no previous diabetes diagnosis or treatment, had a new statin prescription after hospitalization for major CV event (MI, stroke, CABG, or PCI), and had no prescription for a cholesterol-lowering agent in the previous year. Secondary prevention cohorts were assembled for analysis of diabetes incidence among high- vs low-potency statin users; rosuvastatin ≥10 mg, atorvastatin ≥20 mg, and simvastatin ≥40 mg considered higher potency; all other statins classified as lower potency. The study endpoint was hospitalization for new-onset diabetes following a cardiovascular event or procedure, or prescription for oral antihyperglycemic agent or insulin. Mean age was 68 years; a little over half of subjects were male (63%).

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Statin Potency and Diabetes Risk: Design   
Statin Potency and Diabetes Risk: Design 


New cases of diabetes in first 2 years of follow-up
In the first 2 years of follow-up in the current analysis, 3,629 new cases of diabetes were seen in 136,966 subjects. Cases with new diabetes vs matched controls (N=35,623): slightly greater prevalence of CHF and hypertension (and use of medications to treat these conditions).


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Statin Potencey and Diabetes Risk: New Cases of Diabetes in First 2 Years of Follow-Up   
Statin Potency and Diabetes Risk: New Cases of Diabetes in First 2 Years of Follow-Up 

Comparison of higher- vs lower-potency statins
Results from the current study showed that higher- vs lower-potency statins were associated with moderate increased risk of new onset diabetes in patients treated for secondary CVD prevention.

Statin exposure, current therapy (cases vs controls, respectively); fixed effect rate ratio (95% CI) for as treated analysis:

  • ≤2 years: low-dose statins: 954 vs 9,831; high-dose statins: 2,402 vs 22,054; 1.15 (1.05–1.26). There was a 15% higher rate of diabetes with higher vs lower potency statins. To induce one new diabetes case, 342 secondary prevention patients needed to be treated with a higher-potency statin vs a lower-potency statin for 2 years.
  • ≤120 days: low-dose statins: 296 vs 2,818; high-dose statins: 720 vs 5,831; 1.26 (1.07–1.47)

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Higher- Vs Lower-Potency Statins Associated With Moderate Increased Risk of New Onset Diabetes in Patients Treated for Secondary CV Prevention   
Higher- Vs Lower-Potency Statins Associated With Moderate Increased Risk of New Onset Diabetes in Patients Treated for Secondary CVD Prevention 

Rosuvastatin is not FDA approved for secondary prevention

CABG=coronary artery bypass graft; CHF=congestive heart failure; CVD=cardiovascular disease; MI=myocardial infarction; PCI=percutaneous coronary intervention

Related content: 

Overview and slides: Statins and the risk of diabetes: evidence from a large population-based cohort study
Overview and slides: Risk of incident diabetes among patients treated with statins: population based study 

Overview and slides: Comparative tolerability and harms of individual statins. A study-level network meta-analysis of 246,955 participants from 135 randomized, controlled trials

Overview and slides: Do statins interfere with lifestyle intervention in the prevention of diabetes in primary healthcare? One-year follow-up of the FIN-D2D project

Overview and slides: JUPITER Analysis: Do Statin Benefits Outweigh Diabetes Risk?

Expert commentary: Peter Libby, MD, on statins and diabetes risk in JUPITER

Overview and slides: Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials 
 

 
  

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States. 

August 2014 

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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Last Modified: 9/17/2014