Statins and New-Onset Diabetes: A Retrospective Longitudinal Cohort Study
Statins and New-Onset Diabetes: A Retrospective Longitudinal Cohort Study
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DOI：
10.1016/j.clinthera.2012.08.004
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发表时间：
2012-09-01
影响因子：
3.2
通讯作者：
Jong, Gwo-Ping
中科院分区：
文献类型：
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作者：
Ma, Tsochiang;Tien, Liyun;Jong, Gwo-Ping
背景资料：他汀类药物与新发糖尿病（NOD）有关;然而，他汀类药物对高血压和血脂异常患者NOD发生的影响尚未得到很好的研究。目的：本研究的目的是探讨他汀类药物与NOD之间的关系。这是一项回顾性队列研究，使用提供给国家卫生局中央区域分支的索赔表中的数据进行2006年7月至2009年12月在台湾的保险。从处方数据库中检索索引日期之前的他汀类药物处方。我们估计了与他汀类药物使用相关的NOD的风险比（HR）。结果：在研究期间，在16,027例高血压和血脂异常患者中，共发现1360例（8.5%）NOD病例。调整性别和年龄后，普伐他汀（HR，1.34 [95%CI，1.15-1.551]）和阿托伐他汀（HR，1.29 [95%CI，1.16-1.44]）使用者的NOD风险高于非使用者。服用氟伐他汀（HR，0.45 [95%CI，0.34-0.60]）、洛伐他汀（HR，0.71 [95%CI，0.61-0.841]）和瑞舒伐他汀（HR，0.54 [95%CI，0.39-0.77]）的患者发生NOD的风险低于未使用者。辛伐他汀与NOD风险无关。此外，调整合并用药和他汀类药物平均剂量后，阿托伐他汀使用者的NOD风险为中性。普伐他汀，氟伐他汀，洛伐他汀，辛伐他汀和瑞舒伐他汀产生类似的结果调整性别和年龄。结论：这些门诊高血压和血脂异常谁采取氟伐他汀，洛伐他汀和瑞舒伐他汀的NOD的风险较低，而患者谁采取普伐他汀的风险更大。辛伐他汀和阿托伐他汀似乎具有中性效应。我们的研究还表明，阿托伐他汀对NOD风险具有剂量反应效应。由于这是一项描述性研究，因此无法显示所有他汀类药物和NOD的时间性和后续因果关系。需要在更大规模的临床试验中进一步研究和独立确认他汀类药物使用与NOD之间的因果关系。(Clin Ther. 2012;34：1977-1983）（C）2012 Elsevier HS Journals，Inc.Elsevier HS Journals，Inc. All rights reserved.
Background: Statins have been linked to new-onset diabetes (NOD); however, the effect of statins on the development of NOD in patients with hypertension and dyslipidemia has not been well studied.Objective: The goal of this study was to investigate the association between statins and NOD.Methods: This was a retrospective cohort study performed by using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan from July 2006 to December 2009. Prescriptions for statins before the index date were retrieved from a prescription database. We estimated the hazards ratios (HRs) of NOD associated with statin use. Nondiabetic subjects served as the reference group.Results: A total of 1360 (8.5%) NOD cases were identified among 16,027 patients with hypertension and dyslipidemia during the study period. The risk of NOD after adjusting for sex and age was higher among users of pravastatin (HR, 1.34 [95% CI, 1.15-1.551]) and atorvastatin (HR, 1.29 [95% CI, 1.16-1.44]) than among nonusers. Patients who took fluvastatin (HR, 0.45 [95% CI, 0.34-0.60]), lovastatin (HR, 0.71 [95% CI, 0.61-0.841]), and rosuvastatin (HR, 0.54 [95% CI, 0.39-0.77]) were at lower risk of developing NOD than nonusers. Simvastatin was not associated with risk of NOD. Furthermore, the risk of NOD after adjusting for concomitant medication usage and mean dose of statins was neutral among users of atorvastatin. Pravastatin, fluvastatin, lovastatin, simvastatin, and rosuvastatin produced similar results as adjusting for sex and age.Conclusions: These outpatients with hypertension and dyslipidemia who took fluvastatin, lovastatin, and rosuvastatin were at lower risk of NOD, whereas patients who took pravastatin were at greater risk. Simvastatin and atorvastatin seemed to have a neutral effect. Our study also demonstrated that atorvastatin has a dose-response effect on NOD risk. Because this was a descriptive study, temporality and subsequent causality of all statins and NOD could not be shown. Further study and independent confirmation of the causality between statin use and NOD in larger clinical trials are warranted. (Clin Ther. 2012;34:1977-1983) (C) 2012 Elsevier HS Journals, Inc.Elsevier HS Journals, Inc. All rights reserved.