Statins and the risk of diabetes: evidence from a large population-based cohort study

Corrao G, Ibrahim B, Nicotra F, et al. Statins and the risk of diabetes: evidence from a large population-based cohort study. Diabetes Care. 2014;37(8):2225-2232.

This cohort study investigated the relationship between increasing levels of statin adherence and type 2 diabetes. Subjects were from the database of National Health Service in Italy and had ≥1 new statin prescription and no prior diabetes (N=115,709). Adherence was assessed by proportion of days covered (PDC): the cumulative number of days medication was available divided by days of follow-up. Adherence was categorized as very low (PDC <25%), low (PDC 25-49%), intermediate (PDC 50-74%), and high (PDC ≥75%). PDC categories were also considered based on statin potency: rosuvastatin ≥10 mg, atorvastatin ≥20 mg, and simvastatin ≥40 mg considered higher potency; all other statins classified as lower potency. The study outcomes were initiation of antihyperglycemic therapy or hospitalization for type 2 diabetes.

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Statin Adherence and Risk of New-Onset Diabetes: Design   
Statin Adherence and Risk of New-Onset Diabetes: Design 


New-onset type 2 diabetes incidence and characteristics associated with low or very low statin adherence
A total of 11,154 of 115,709 subjects received antihyperglycemic therapy or were hospitalized for type 2 diabetes (study outcomes). The incidence rate was 14.9 new cases of diabetes/1,000 person-years. More than 50% of subjects had very low or low statin adherence (57% vs 43% with intermediate or high adherence).

Very low or low statin adherence was more common in:

  • Women
  • Initial therapy with fluvastatin or pravastatin
  • No use of other medications
  • No previous CVD hospitalization
  • No chronic comorbidities 
     


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New-Onset Type 2 Diabetes Incidence and Characteristics Associated With Low or Very Low Statin Adherence   
New-Onset Type 2 Diabetes Incidence and Characteristics Associated With Low or Very Low Statin Adherence 


Continuous statin use associated with increased risk of new-onset type 2 diabetes
A significant trend toward increased risk of new-onset diabetes was seen with increasing statin adherence. The benefits of statins in reducing cardiovascular events overwhelm the diabetes risk.

  • Excess risk of new-onset diabetes among subjects with more continuous statin use vs subjects using statins for shorter time
  • Statistical evidence that effect of statins on diabetes risk differed based on potency

HR (95% CI) for diabetes by PDC:*

  • Very low (PDC <25%): 1.00 (reference)
  • Low (PDC 25-49%): 1.12 (1.06-1.18)
  • Intermediate (PDC 50-74%): 1.21 (1.14-1.27)
  • High (PDC ≥75%): 1.32 (1.26-1.39)  
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Continuous Statin Use Associated With Increased Risk of New-Onset Type 2 Diabetes   
Continuous Statin Use Associated With Increased Risk of New-Onset Type 2 Diabetes 


*Estimates for all statins; adjusted for age, sex, first-line statin therapy, concomitant use of other drugs, CVD history, and comorbidities
CVD=cardiovascular disease

Related content: 

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

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: 8/14/2014