Statins, Risk of Diabetes, and Implications on Outcomes in the General Population
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Fran
Aug 15, 2012, 6:14:56 AM8/15/12
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Hello Group,
The conclusion seems to want it both ways. How is the increased risk of diabetes a "favorable outcome"???
Fran
Available online 8 August 2012
http://www.sciencedirect.com/science/article/pii/S0735109712020694
Objectives
This analysis 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;xx:xxx)
© 2012 by the American College of Cardiology Foundation
The conclusion seems to want it both ways. How is the increased risk of diabetes a "favorable outcome"???
Fran
Available online 8 August 2012
http://www.sciencedirect.com/science/article/pii/S0735109712020694
Objectives
This analysis 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;xx:xxx)
© 2012 by the American College of Cardiology Foundation
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