Statins for primary prevention: do benefits outweigh DM risk?

  • Ko MJ & al.
  • J Am Heart Assoc
  • 16 Apr 2019

  • International Clinical Digest
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Takeaway

  • Statin use was associated with significantly increased time- and dose-dependent risk of new-onset diabetes mellitus (DM).
  • Data suggest caution in use of high-dose statins for long-term primary prevention.  

Why this matters

  • Indications for statin use in primary and secondary prevention have been expanding, but safety regarding increased DM risk is controversial.

Study design

  • From national health insurance data, comparison of 638,625 statin users with 1,523,494 never-users, all aged ≥40 years with hypercholesterolemia.
  • Propensity-score matching identified 518,491 matched pairs of statin users and nonusers with similar baseline characteristics.
  • Funding: National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.

Key results

  • In average 3.9-year follow-up, new-onset DM occurred in 13.4 vs 6.9/1000 person-years among statin users and nonusers, respectively (adjusted HR [aHR], 1.88; 95% CI, 1.85-1.93).
  • DM risk increased by statin use duration, with aHR, 2.62 (2.56-2.67) for >2 years vs 1.25 (1.21-1.28) for
  • By statin intensity, aHR was 2.31 (2.26-2.37) for high vs 1.75 (1.71-1.78) for low.  
  • By cumulative dose, aHR was 2.52 (2.47-2.57) for third tertile vs 1.06 (1.02-1.10) for first tertile.

Limitations

  • Record-based data.  
  • Nonrandomized, observational.
  • No data on high-density lipoprotein cholesterol, triglycerides.
  • Possible survivor bias.
  • Single country.