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European Journal of Epidemiology

, Volume 31, Issue 8, pp 747–761 | Cite as

Impact of incident diabetes on atherosclerotic cardiovascular disease according to statin use history among postmenopausal women

  • Yunsheng MaEmail author
  • Gioia M. Persuitte
  • Christopher Andrews
  • Kathleen M. Hovey
  • Michael J. LaMonte
  • Annie L. Culver
  • JoAnn E. Manson
  • Lawrence S. Phillips
  • Simin Liu
  • Charles Eaton
  • Lisa W. Martin
  • Barbara V. Howard
  • Raji Balasubramanian
  • Chloe E. Bird
  • Ira S. Ockene
  • Susan R. Sturgeon
  • Judith K. Ockene
  • Lesley Tinker
  • Rami Nassir
  • Jacques Rossouw
CARDIOVASCULAR DISEASE

Abstract

To compare impact of incident diabetes on atherosclerotic cardiovascular disease (ASCVD) risk among postmenopausal women according to statin use. Prospective data from 120,499 postmenopausal women without prevalent diabetes or cardiovascular disease at baseline from the Women’s Health Initiative were used. Incident diabetes was self-reported annually and defined as treatment with pills or injectable medication for diabetes. Current statin use was determined at enrollment and years 1, 3, 6, 9 and 13.5 in the three clinical trial arms, and at baseline, year 3, and 13.5 for the observational study. The primary outcome was incident ASCVD events, self-reported annually and adjudicated by blinded local and central physicians. Incident diabetes and statin use status were fitted as time-varying covariates in Cox regression models to assess ASCVD risk during an average follow-up of 13.6 years. For those not on statins at the time of diabetes diagnosis, there was a 42 % increased risk of ASCVD [hazard ratio (HR) 1.42, 95 % CI 1.28–1.58] among women with incident diabetes versus those without diabetes. Among women on statins, there was a 39 % increased risk of ASCVD (HR 1.39, 95 % CI 1.12–1.74) in women with incident diabetes versus those without diabetes. The increased ASCVD risk due to diabetes was similar between women before or after initiating statins (P = 0.89). Whether diabetes was diagnosed before or after statin use did not alter the increased risk of ASCVD associated with diabetes. Mitigating the increased incidence of diabetes in statin users could increase the ASCVD benefit-to-risk ratio of statins.

Keywords

Epidemiology Diabetes Drug-related problem Cardiovascular disease 

Notes

Acknowledgments

Y.M. and G.M.P wrote the manuscript and researched data. A.L.C., J.E.M., L.S.P., S.L., C.E., M.L., L.W.M, B.V.H, R.B., C.E.B., I.S.O., S.R.S., J.K.O., L.T, R.N., and J.R. contributed to the discussion and reviewed and edited the manuscript. C.A. and K. H performed data analyses and reviewed and edited the manuscript. The Women’s Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221. Our investigation also was supported in part by 5R01HL122241-02. A list of WHI investigators is available in Supplementary Data online. The authors thank the principal investigators of all WHI clinical centers and the data coordinating center for their contribution to the study. They are also indebted to the dedicated and committed participants of the WHI.

References

  1. 1.
    Eldor R, Raz I. American Diabetes Association indications for statins in diabetes: is there evidence? Diabetes Care. 2009;32(Suppl 2):S384–91.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ma Y, Hebert J, Ebbeling C, Ockene I. International aspects of coronary heart disease epidemiology. In: Becker RC, Alpert JS, editors. Cardiovascular medicine-practice and management. London: Arnold; 2001.Google Scholar
  3. 3.
    Ma Y, Hebert JR, Balasubramanian R, et al. All-cause, cardiovascular, and cancer mortality rates in postmenopausal white, black, hispanic, and asian women with and without diabetes in the United States: the women’s health initiative, 1993–2009. Am J Epidemiol. 2013;178:1533–41.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1–45.CrossRefPubMedGoogle Scholar
  5. 5.
    American Diabetes A (8). Cardiovascular disease and risk management. Diabetes Care. 2015;38(Suppl):49–57.CrossRefGoogle Scholar
  6. 6.
    Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375:735–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA J Am Med Assoc. 2011;305:2556–64.CrossRefGoogle Scholar
  8. 8.
    Waters DD, Ho JE, DeMicco DA, et al. Predictors of new-onset diabetes in patients treated with atorvastatin: results from 3 large randomized clinical trials. J Am Coll Cardiol. 2011;57:1535–45.CrossRefPubMedGoogle Scholar
  9. 9.
    Swerdlow DI, Preiss D, Kuchenbaecker KB et al. HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence from genetic analysis and randomised trials. Lancet 2014;385:351–61.Google Scholar
  10. 10.
    Navarese EP, Buffon A, Andreotti F, et al. Meta-analysis of impact of different types and doses of statins on new-onset diabetes mellitus. Am J Cardiol. 2013;111:1123–30.CrossRefPubMedGoogle Scholar
  11. 11.
    Mora S, Glynn RJ, Hsia J, MacFadyen JG, Genest J, Ridker PM. Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials. Circulation. 2010;121:1069–77.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380:565–71.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    The Women’s Health Initiative Study Group. Design of the women’s health initiative clinical trial and observational study. Control Clin Trials. 1998;19:61–109.CrossRefGoogle Scholar
  14. 14.
    Margolis K, Qi L, Brzyski R, et al. Validity of diabetes self-reports in the women’s health initiative: comparison with medication inventories and fasting glucose measurements. Clin Trials. 2008;5(3):240–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Jackson JM, DeFor TA, Crain AL, et al. Validity of diabetes self-reports in the Women’s Health Initiative. Menopause. 2014;21:861–8.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T. Measurement characteristics of the Women’s Health Initiative food frequency questionnaire. Ann Epidemiol. 1999;9:178–87.CrossRefPubMedGoogle Scholar
  17. 17.
    Kennedy ET, Ohls J, Carlson S, Fleming K. The Healthy Eating Index: design and applications. J Am Diet Assoc. 1995;95:1103–8.CrossRefPubMedGoogle Scholar
  18. 18.
    McCullough ML, Willett WC. Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index. Public Health Nutr. 2006;9:152–7.CrossRefPubMedGoogle Scholar
  19. 19.
    McCullough ML, Feskanich D, Stampfer MJ, et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002;76:1261–71.PubMedGoogle Scholar
  20. 20.
    Belin RJ, Greenland P, Allison M, et al. Diet quality and the risk of cardiovascular disease: the Women’s Health Initiative (WHI). Am J Clin Nutr. 2011;94:49–57.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Qiao Y, Tinker L, Olendzki BC, et al. Racial/ethnic disparities in association between dietary quality and incident diabetes in postmenopausal women in the United States: the Women’s Health Initiative 1993–2005. Ethn Health 2013;19:328–47.Google Scholar
  22. 22.
    Cox D. Regression models and life-tables. J Roy Stat Soc. 1972;34:187–220.Google Scholar
  23. 23.
    Hosmer DW, Lemeshow S, May S. Applied survival analysis: regression modeling of time to event data. New York: Wiley; 2008.CrossRefGoogle Scholar
  24. 24.
    Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–52.CrossRefPubMedGoogle Scholar
  25. 25.
    Ford ES, Li C, Zhao G. Prevalence and correlates of metabolic syndrome based on a harmonious definition among adults in the US. J Diabetes. 2010;2:180–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Cholesterol Treatment Trialists’ CTT C. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012;380:581–90.Google Scholar
  27. 27.
    Kostis WJ, Cheng JQ, Dobrzynski JM, Cabrera J, Kostis JB. Meta-analysis of statin effects in women versus men. J Am Coll Cardiol. 2012;59:572–82.CrossRefPubMedGoogle Scholar
  28. 28.
    Cholesterol Treatment Trialists C. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174000 participants in 27 randomised trials. Lancet 2015;385:1397–1405.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Yunsheng Ma
    • 1
    Email author
  • Gioia M. Persuitte
    • 2
  • Christopher Andrews
    • 3
  • Kathleen M. Hovey
    • 4
  • Michael J. LaMonte
    • 4
  • Annie L. Culver
    • 1
  • JoAnn E. Manson
    • 5
  • Lawrence S. Phillips
    • 6
  • Simin Liu
    • 7
  • Charles Eaton
    • 8
  • Lisa W. Martin
    • 9
  • Barbara V. Howard
    • 10
  • Raji Balasubramanian
    • 11
  • Chloe E. Bird
    • 12
  • Ira S. Ockene
    • 13
  • Susan R. Sturgeon
    • 11
  • Judith K. Ockene
    • 1
  • Lesley Tinker
    • 14
  • Rami Nassir
    • 15
  • Jacques Rossouw
    • 16
  1. 1.Division of Preventive and Behavioral Medicine, Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Corrona LLCSouthboroughUSA
  3. 3.Department of Ophthalmology and Visual SciencesUniversity of MichiganAnn ArborUSA
  4. 4.Department of Epidemiology and Environmental HealthState University of New York at BuffaloBuffaloUSA
  5. 5.Division of Preventive Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  6. 6.Division of EndocrinologyEmory UniversityAtlantaUSA
  7. 7.School of Public HealthBrown UniversityProvidenceUSA
  8. 8.Department of Family Medicine, School of MedicineBrown UniversityProvidenceUSA
  9. 9.Division of Cardiology, School of Medicine and Health SciencesGeorge Washington UniversityWashingtonUSA
  10. 10.MedStar Research InstituteHyattsvilleUSA
  11. 11.Department of Biostatistics and EpidemiologyUniversity of Massachusetts AmherstAmherstUSA
  12. 12.RAND CorporationSanta MonicaUSA
  13. 13.Division of Cardiovascular Medicine, Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterUSA
  14. 14.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
  15. 15.Department of Biochemistry and Molecular MedicineUniversity of California DavisDavisUSA
  16. 16.Women’s Health Initiative Branch, National Heart, Lung, and Blood InstituteBethesdaUSA

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