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Use of Statins and the Risk of Incident Diabetes: A Retrospective Cohort Study

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Abstract

Introduction

Even though several landmark statin trials have demonstrated the beneficial effects of statin therapy in both primary and secondary prevention of cardiovascular disease, several studies have suggested that statins are associated with a moderate increase in risk of new-onset diabetes. These observations prompted the US FDA to revise statin labels to include a warning of an increased risk of incident diabetes mellitus as a result of increases in glycosylated hemoglobin (HbA1c) and fasting plasma glucose. However, few studies have used US-based data to investigate this statin-associated increased risk of diabetes.

Objective

The primary objective of our study was to examine whether the use of statins increases the risk of incident diabetes mellitus using data from the Thomson Reuters MarketScan ® Commercial Claims and Encounters Database.

Method

This study was a retrospective cohort analysis utilizing data for the period 2003–2004. The study population included new statin users aged 20–63 years at index who did not have a history of diabetes.

Results

The proportion (3.4 %) of statin users (N = 53,212) who had incident diabetes was higher than the proportion (1.2 %) of non-statin users (N = 53,212) who had incident diabetes. Compared with no statin use and controlling for demographic and clinical covariates, statin use was significantly associated with increased risk of incident diabetes (hazard ratio 2.01; 99 % confidence interval 1.74–2.33; p < 0.0001). In addition, risk of diabetes was highest among users of lovastatin, atorvastatin, simvastatin, and fluvastatin. Diabetes risk was lowest among pravastatin and rosuvastatin users.

Discussion

Because the potential for diabetogenicity differs among different statin types, healthcare professionals should individualize statin therapy by identifying patients who would benefit more from less diabetogenic statin types.

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Acknowledgments

The authors acknowledge Thomson Reuters for providing us with the 2003–2004 MarketScan data as part of the Thomson Reuter’s MarketScan Dissertation Support Program.

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Authors and Affiliations

  1. Department of Pharmacy Practice, University of Kansas School of Pharmacy, 2010 Becker Dr., Lawrence, KS, 66047, USA

    Busuyi S. Olotu & Rafia S. Rasu

  2. Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, The University of Texas at Austin, 2409 University Avenue A1930, Austin, TX, 78712-1120, USA

    Busuyi S. Olotu, Marvin D. Shepherd, Suzanne Novak, Kenneth A. Lawson, James P. Wilson & Kristin M. Richards

  3. Austin Outcomes Research, 1600 Flintridge Rd, West Lake Hills, TX, 78746, USA

    Busuyi S. Olotu & Suzanne Novak

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  1. Busuyi S. Olotu
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Correspondence to Busuyi S. Olotu.

Ethics declarations

This study complied with standards required for observational study of de-identified data. The study did not involve human subjects.

Funding

No external funding was used in the preparation of this manuscript.

Conflict of interest

All authors, Busuyi Olotu, Marvin Shepherd, Suzanne Novak, Kenneth Lawson, James Wilson, Kristin Richards, and Rafia Rasu, declare they have no conflicts of interest that might be relevant to the contents of this manuscript.

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Olotu, B.S., Shepherd, M.D., Novak, S. et al. Use of Statins and the Risk of Incident Diabetes: A Retrospective Cohort Study. Am J Cardiovasc Drugs 16, 377–390 (2016). https://doi.org/10.1007/s40256-016-0176-1

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