Association of statins with diabetes mellitus and diabetic complications: role of confounders during follow-up
Association of statins with diabetes mellitus and diabetic complications: role of confounders during follow-up
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DOI：
10.1136/jim-2016-000218
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发表时间：
2017-01-01
影响因子：
2.6
通讯作者：
Mortensen, Eric M.
中科院分区：
文献类型：
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作者：
Mansi, Ishak A.;Frei, Christopher R.;Mortensen, Eric M.
研究表明，他汀类药物的使用会增加糖尿病和糖尿病并发症的风险。这些研究通常确保他汀类药物使用者和非使用者在基线时的可比性；然而，大多数研究忽视了在随访期间发生的混杂因素。如果不考虑这些混杂因素，例如新的药物或程序，可能会导致发现他汀类药物与结果之间的虚假关联。这项研究的目的是检查他汀类药物与糖尿病和糖尿病并发症的关系；并在随访期内检查可能影响这种关系的潜在混杂因素。我们使用Tricare数据进行了一项回溯性队列研究(从2003年10月1日至2012年3月31日)。在开始服用他汀类药物之前，我们对他汀类药物使用者和非使用者的115个基线特征进行了倾向性评分匹配；这些特征可能与他汀类药物的使用或感兴趣的结果相关。结果包括糖尿病和糖尿病并发症的风险。在60,455名患者中(10,910名他汀类药物使用者和49,545名非使用者)，我们对6728名他汀类药物使用者和6728名非使用者进行了倾向得分匹配。使用他汀类药物的患者发生糖尿病(OR 1.34，95%CI 1.24~1.44)和糖尿病合并并发症(OR 1.28，95%CI 1.16~1.42)的OR值较高。对随访期内发生的潜在混杂因素的调整并不能解释或减少他汀类药物与不良结果之间的关联。与类似的非服用他汀类药物的人相比，使用他汀类药物的人更容易被诊断出患有糖尿病和糖尿病并发症，即使在对随访期间发生的潜在混杂因素进行调整后也是如此。
Studies have associated statin use with increased risk of diabetes and diabetic complications. These studies often ensure comparability of statin users and non-users at baseline; however, most studies neglect to consider confounders that occur during follow-up. Failure to consider these confounders, such as new medications or procedures, may result in identification of a spurious association between statins and outcomes. The objective of this study was to examine the association of statins with diabetes mellitus and diabetic complications; and to examine potential confounders during the follow-up period that might affect this relationship. We conducted a retrospective cohort study using Tricare data (from October 1, 2003 to March 31, 2012). We propensity score-matched statin users and non-users on 115 baseline characteristics before starting statins; these characteristics would be potentially associated with the use of statins or the outcomes of interest. Outcomes included the risk of diabetes mellitus and diabetic complications. Out of 60,455 patients (10,910 statin users and 49,545 non-users), we propensity score-matched 6728 statin users to 6728 non-users. Statin users had higher ORs for diabetes (OR 1.34, 95% CI 1.24 to 1.44) and diabetes with complications (OR 1.28, 95% CI 1.16 to 1.42). Adjustment for potential confounders that occurred during the follow-up period did not explain or diminish the association between statins and adverse outcomes. Statin users in comparison to similar non-users were more commonly diagnosed with diabetes and diabetic complications, even after adjustment for potential confounders that occurred during the follow-up period.