Statins, Risk of Diabetes, and Implications on Outcomes in the General Population

被引：100

作者：

Wang, Kang-Ling ^{[2
,3
,4
]}

Liu, Chia-Jen ^{[3
]}

Chao, Tze-Fan ^{[3
,4
]}

Huang, Chi-Ming ^{[3
,4
]}

Wu, Cheng-Hsueh ^{[3
,4
]}

Chen, Su-Jung ^{[3
,4
]}

Chen, Tzeng-Ji ^{[5
,6
]}

Lin, Shing-Jong ^{[2
,3
,4
,7
]}

Chiang, Chern-En ^{[1
,2
,3
,4
,7
]}

机构：

[1] Taipei Vet Gen Hosp, Gen Clin Res Ctr, Taipei 11217, Taiwan

[2] Taipei Vet Gen Hosp, Dept Med Res & Educ, Taipei 11217, Taiwan

[3] Taipei Vet Gen Hosp, Dept Med, Taipei 11217, Taiwan

[4] Natl Yang Ming Univ, Sch Med, Taipei 112, Taiwan

[5] Taipei Vet Gen Hosp, Dept Family Med, Taipei 11217, Taiwan

[6] Natl Yang Ming Univ, Inst Hosp & Hlth Care Adm, Taipei 112, Taiwan

[7] Natl Yang Ming Univ, Cardiovasc Res Ctr, Taipei 112, Taiwan

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 60卷 / 14期

关键词：

diabetes; outcome research; statins; RANDOMIZED-TRIALS; GLUCOSE-METABOLISM; PRIMARY PREVENTION; CLINICAL-PRACTICE; METAANALYSIS; CHOLESTEROL; MELLITUS; THERAPY; DISEASE; SAFETY;

D O I：

10.1016/j.jacc.2012.05.019

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population. Background Cardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occurrence according to clinical trial analyses. From daily-practice perspectives, it remains unclear whether statin use increases risk; prognoses of diabetes after exposure require further clarification. Methods From Taiwan National Health Insurance beneficiaries age >= 45 years (men) and >= 55 years ( women) before 2004, subjects continuously treated with statins >= 30 days during 2000 to 2003 and nonusers before 2004 were identified. Among nondiabetic individuals at the cohort entry, controls were matched to statin users on a 4:1 ratio by age, sex, atherosclerotic comorbidities, and year of their entry. Outcomes as diabetes, major adverse cardiovascular events (MACE, the composite of myocardial infarction and ischemic stroke), and in-hospital deaths were assessed. Results Over a median of 7.2 years, annual rates of diabetes were significantly higher in statin users (2.4% vs. 2.1%, p < 0.001), whereas MACE (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.68 to 0.98 for myocardial infarction; HR: 0.94; 95% CI: 0.86 to 1.03 for ischemic stroke; HR: 0.91; 95% CI: 0.84 to 0.99 for MACE]) and in-hospital mortality (HR: 0.61; 95% CI: 0.55 to 0.67]) were less. The risk-benefit analyses suggested that statin treatment was favorable in high-risk (HR: 0.89; 95% CI: 0.83 to 0.95) and secondary prevention (HR: 0.89; 95% CI: 0.83 to 0.96) populations. Among diabetic patients, prior statin use was associated with fewer MACE (HR: 0.75; 95% CI: 0.59 to 0.97). In-hospital deaths were similar in statin-related diabetes among high-risk (HR: 1.11; 95% CI: 0.83 to 1.49) and secondary prevention (HR: 1.08; 95% CI: 0.79 to 1.47) subjects compared with nondiabetic controls. Conclusions Risk of diabetes was increased after statins, but outcomes were favorable. (J Am Coll Cardiol 2012;60:1231-8) (c) 2012 by the American College of Cardiology Foundation

引用

页码：1231 / 1238

页数：8

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