Risk of incident diabetes among patients treated with statins: population based study

Carter AA, Gomes T, Camacho X, Juurlink DN, Shah BR, Mamdani MM. Risk of incident diabetes among patients treated with statins: population based study. BMJ. 2013;346:f2610 doi:10.1136/bmj.f2610.

This retrospective cohort study examined the relationship between new-onset diabetes and use of different statins. Subjects (N=471,250) were aged ≥66 years, were new statin users, and had no diabetes history. The primary outcome was incident diabetes over 14 years. Use of statins for primary or secondary prevention was also examined. Statins assessed in the study: atorvastatin, fluvastatin, lovastatin, pravastatin (reference drug), rosuvastatin, and simvastatin.* 

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04 - Incident Diabetes by Statin Use Design

Rates of incident diabetes over follow-up of 14 years:

Agent
The rate of incident diabetes was highest for atorvastatin and rosuvastatin compared with pravastatin. Increased risk of new-onset diabetes was seen in patients treated with atorvastatin, rosuvastatin, and simvastatin vs pravastatin. The number of outcomes/1000 person-years (adjusted hazard ratio [95% confidence interval]:

  • Pravastatin (n=38,470): 22.64 (reference drug)
  • Atorvastatin (n=268,254): 30.70 (1.22 [1.15 to 1.29])
  • Fluvastatin (n=5,636): 21.52 (0.95 [0.81 to 1.11])
  • Lovastatin (n=6,287): 21.80 (0.99 [0.86 to 1.14])
  • Rosuvastatin (n=76,774): 34.21 (1.18 [1.10 to 1.26])
  • Simvastatin (n=75,829): 26.22 (1.10 [1.04 to 1.17])

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01 - Incident Diabetes Rate Highest for

Primary or Secondary Prevention*
The rate of incident diabetes was highest for atorvastatin and rosuvastatin compared with pravastatin for both primary and secondary prevention.
For primary prevention, the number of outcomes/1000 person-years (adjusted hazard ratio [95% confidence interval]:

  • Pravastatin (n=17,901): 22.80 (reference drug)
  • Atorvastatin (n=124,925): 31.45 (1.20 [1.10 to 1.30])
  • Fluvastatin (n=3,066): 22.34 (0.98 [0.79 to 1.22])
  • Lovastatin (n=3,241): 22.11 (1.01 [0.82 to 1.23])
  • Rosuvastatin (n=46,591): 34.92 (1.12 [1.02 to 1.23])
  • Simvastatin (n=32,270): 27.41 (1.12 [1.02 to 1.23])

For secondary prevention, the number of outcomes/1000 person-years (adjusted hazard ratio [95% confidence interval]:

  • Pravastatin (n=20,569): 22.51 (reference drug)
  • Atorvastatin (n=143,329): 30.11 (1.25 [1.16 to 1.34])
  • Fluvastatin (n=2,570): 20.62 (0.91 [0.72 to 1.15])
  • Lovastatin (n=3,046): 21.48 (0.97 [0.79 to 1.20])
  • Rosuvastatin (n=30,183): 33.18 (1.24 [1.13 to 1.36])
  • Simvastatin (n=43,559): 25.44 (1.10 [1.01 to 1.19] 

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02 - Incident Diabetes Rate Highest for

Potency
The rate of incident diabetes was greater for high- vs moderate- or low-potency statins compared with pravastatin. The number of outcomes/1000 person-years (adjusted hazard ratio [95% confidence interval]:

  • Pravastatin (n=38,470): 22.64 (reference drug)
  • High potency (atorvastatin, rosuvastatin; n=345,028): 31.34 (1.22 [1.15 to 1.29)
  • Moderate potency (simvastatin; n=75,829): 26.22 (1.11 [1.04 to 1.18])
  • Low potency (fluvastatin, lovastatin; n=11,923): 21.68 (0.97 [0.87 to 1.09]) 

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03 - Incident Diabetes Rate Greater with   

*Fluvastatin is not FDA approved for primary prevention. Rosuvastatin is not FDA approved for secondary prevention. 

  

 The 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. 

September 2013 

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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