Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults
Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults
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DOI：
10.1007/s11606-015-3335-1
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发表时间：
2015-11-01
影响因子：
5.7
通讯作者：
Mortensen, Eric M.
中科院分区：
文献类型：
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作者：
Mansi, Ishak;Frei, Christopher R.;Mortensen, Eric M.
他汀类药物的使用与糖尿病发病率增加有关，并可能与体重增加和运动能力下降有关。然而，有关这些关联对健康成年人的长期影响的数据非常有限。此外，这些效应与糖尿病并发症之间的关系尚未得到充分研究。为了检查健康成年人队列中他汀类药物的使用与新发糖尿病、糖尿病并发症和超重/肥胖之间的关联。这是一项回顾性队列研究。受试者是2003年10月1日至2012年3月1日期间接受评估的Tricare受益人。患者分为他汀类药物使用者和非使用者。我们排除了在基线时患有以下疾病的患者：先前存在的表明心血管疾病的疾病、查尔森合并症指数的任何阳性要素（包括糖尿病）或限制生命的慢性疾病。使用 42 个基线特征，我们生成了一个倾向评分来匹配他汀类药物使用者和非使用者。评估的结果包括新发糖尿病、糖尿病并发症和超重/肥胖。总共 25,970 名患者（3982 名他汀类药物使用者和 21,988 名非使用者）在基线时被确定为健康成年人。其中，3351 名他汀类药物使用者和 3351 名非使用者进行了倾向评分匹配。他汀类药物使用者患新发糖尿病（比值比 [OR] 1.87；95% 置信区间 [95% CI] 1.67-2.01）、糖尿病并发症（OR 2.50；95% CI 1.88-3.32）和超重/肥胖（OR 1.14；95% CI 1.04-1.25）的几率较高。二次分析和敏感性分析显示了类似的结果。在健康成人队列中，他汀类药物使用者比类似的非使用者更常诊断出糖尿病、糖尿病并发症和超重/肥胖。这项研究表明，短期临床试验可能无法完全描述长期使用他汀类药物进行一级预防的风险/益处。
Statin use is associated with increased incidence of diabetes and possibly with increased body weight and reduced exercise capacity. Data on the long-term effects of these associations in healthy adults, however, are very limited. In addition, the relationship between these effects and diabetic complications has not been adequately studied.To examine the association between statin use and new-onset diabetes, diabetic complications, and overweight/obesity in a cohort of healthy adults.This was a retrospective cohort study.Subjects were Tricare beneficiaries who were evaluated between October 1, 2003 and March 1, 2012. Patients were divided into statin users and nonusers.We excluded patients who, at baseline, had a preexisting disease indicative of cardiovascular diseases, any positive element of the Charlson comorbidity index (including diabetes mellitus), or life-limiting chronic diseases. Using 42 baseline characteristics, we generated a propensity score to match statin users and nonusers.Outcomes assessed included new-onset diabetes, diabetic complications, and overweight/obesity.A total of 25,970 patients (3982 statin users and 21,988 nonusers) were identified as healthy adults at baseline. Of these, 3351 statins users and 3351 nonusers were propensity score-matched. Statin users had higher odds of new-onset diabetes (odds ratio [OR] 1.87; 95 % confidence interval [95 % CI] 1.67-2.01), diabetes with complications (OR 2.50; 95 % CI 1.88-3.32), and overweight/obesity (OR 1.14; 95 % CI 1.04-1.25). Secondary and sensitivity analyses demonstrated similar findings.Diabetes, diabetic complications, and overweight/obesity were more commonly diagnosed among statin-users than similar nonusers in a healthy cohort of adults. This study demonstrates that short-term clinical trials might not fully describe the risk/benefit of long-term statin use for primary prevention.