Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study

Nielsen SF, Nordestgaard BG. Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study. Lancet Diabetes Endocrinol. 2014. [ePub ahead of print] doi: 10.1016/S2213-8587(14)70173-1.

This study assessed whether statin use increases the risk of microvascular disease among patients with type 2 diabetes.

Nielsen and Nordestgaard led a nested matched study of 62,716 patients diagnosed with incident type 2 diabetes. Median follow-up was 2.7 years. Subjects who regularly used statins prior to diabetes diagnosis (n=15,679) were matched 1:3 with 47,037 subjects who never used statins (nonstatin users) prior to diagnosis; matching was according to sex, age at diabetes diagnosis, year of diabetes diagnosis, and history of cardiovascular disease with 3 patients who did not use statins. Only subjects who used statins before a diagnosis of incident diabetes or preceding the start of antihyperglycemic treatment were included.

The primary outcome was incidence of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and gangrene of the foot. Although the latter is not a microvascular disease, it was included as part of the primary outcome because diabetic neuropathy can increase the risk of the disorder.

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Statin Use and the Risk of Microvascular Disease  
Statin Use and the Risk of Microvascular Disease 

Statin Use Not Associated With Increased Microvascular Risk 

Accounting for the competing risk of death and inclusion of all of 186,295 individuals with diabetes (ie, the population from which the random sample was drawn) gave similar results. Adjusting for lead-time bias (ie, the potential that those taking statins visit a family doctor more often and therefore have an earlier diabetes diagnosis) also yielded similar results. 
Long-term statin use (up to 10 years) gave similar results (not significant for some outcomes) Statin users did not receive increased or decreased glucose-lowering treatment after diagnosis of diabetes compared with nonusers. The multivariate adjusted hazard ratio for the risk of developing diabetes in statin users was 1.17 (95% CI, 1.14–1.21).


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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. 

October 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: 10/17/2014