Risk of incident diabetes among patients treated with statins: population based study.
Risk of incident diabetes among patients treated with statins: population based study.
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他汀类药物治疗的患者中发生糖尿病的风险：基于人群的研究。
DOI：
10.1136/bmj.f2610
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发表时间：
2013-05-23
期刊：
影响因子：
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通讯作者：
Mamdani MM
中科院分区：
文献类型：
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作者：
Carter AA;Gomes T;Camacho X;Juurlink DN;Shah BR;Mamdani MM
目的探讨不同HMG-CoA还原酶抑制剂（他汀类药物）治疗患者新发糖尿病的风险。设计以人群为基础的队列研究，用时间到事件分析来估计特定他汀类药物的使用与糖尿病的发生之间的关系。计算风险比以确定他汀类药物的剂量和类型对发生糖尿病风险的影响。加拿大安大略省。所有从1997年8月1日至2010年3月31日开始接受他汀类药物治疗的66岁及以上无糖尿病患者。该分析仅限于至少在前一年没有服用他汀类药物的新使用者。治疗开始前已确诊糖尿病的患者被排除在外。干预措施：他汀类药物治疗。主要结局指标：糖尿病事件。结果与普伐他汀（所有分析的参考药物）相比，阿托伐他汀（校正风险比1.22,95%可信区间1.15 ~ 1.29）、瑞舒伐他汀（校正风险比1.18,95%可信区间1.10 ~ 1.26）和辛伐他汀（校正风险比1.10,95%可信区间1.04 ~ 1.17）组发生糖尿病的风险增加。氟伐他汀组（0.95,0.81 - 1.11）或洛伐他汀组（0.99,0.86 - 1.14）的风险无显著增加。阿托伐他汀和瑞舒伐他汀的绝对糖尿病发生率分别为每1000人年31例和34例。辛伐他汀的绝对风险（每1000人年26个结果）略低于普伐他汀（每1000人年23个结果）。无论他汀类药物用于心血管疾病的一级预防还是二级预防，我们的研究结果都是一致的。当他汀类药物按效价分组时，虽然观察到类似的结果，但当考虑剂量时，与瑞舒伐他汀使用相关的糖尿病发生风险变得不显著（校正风险比1.01,0.94至1.09）。结论与普伐他汀相比，使用更有效的他汀类药物，尤其是阿托伐他汀和辛伐他汀，可能会增加新发糖尿病的风险。
Objective To examine the risk of new onset diabetes among patients treated with different HMG-CoA reductase inhibitors (statins). Design Population based cohort study with time to event analyses to estimate the relation between use of particular statins and incident diabetes. Hazard ratios were calculated to determine the effect of dose and type of statin on the risk of incident diabetes. Setting Ontario, Canada. Participants All patients aged 66 or older without diabetes who started treatment with statins from 1 August 1997 to 31 March 2010. The analysis was restricted to new users who had not been prescribed a statin in at least the preceding year. Patients with established diabetes before the start of treatment were excluded. Interventions Treatment with statins. Main outcome measure Incident diabetes. Results Compared with pravastatin (the reference drug in all analyses), there was an increased risk of incident diabetes with atorvastatin (adjusted hazard ratio 1.22, 95% confidence interval 1.15 to 1.29), rosuvastatin (1.18, 1.10 to 1.26), and simvastatin (1.10, 1.04 to 1.17). There was no significantly increased risk among people who received fluvastatin (0.95, 0.81 to 1.11) or lovastatin (0.99, 0.86 to 1.14). The absolute risk for incident diabetes was about 31 and 34 events per 1000 person years for atorvastatin and rosuvastatin, respectively. There was a slightly lower absolute risk with simvastatin (26 outcomes per 1000 person years) compared with pravastatin (23 outcomes per 1000 person years). Our findings were consistent regardless of whether statins were used for primary or secondary prevention of cardiovascular disease. Although similar results were observed when statins were grouped by potency, the risk of incident diabetes associated with use of rosuvastatin became non-significant (adjusted hazard ratio 1.01, 0.94 to 1.09) when dose was taken into account. Conclusions Compared with pravastatin, treatment with higher potency statins, especially atorvastatin and simvastatin, might be associated with an increased risk of new onset diabetes.