Statin use and risk of new-onset diabetes: A meta-analysis of observational studies
Statin use and risk of new-onset diabetes: A meta-analysis of observational studies
复制标题
DOI：
10.1016/j.numecd.2017.03.001
复制
发表时间：
2017-05-01
影响因子：
3.9
通讯作者：
Catapano, A. L.
中科院分区：
文献类型：
--
作者：
Casula, M.;Mozzanica, F.;Catapano, A. L.
背景和目标：随机对照试验的荟萃分析调查了糖尿病事件和他汀类药物使用之间的关系，结果显示，与他汀类药物相关的新发糖尿病（NOD）风险从9%增加到13%。然而，短的随访期，无把握的样本量，以及缺乏预先规定的糖尿病诊断标准可能是低估这种风险的原因。我们对已发表的观察性研究进行了荟萃分析，以评估他汀类药物使用与NOD.Methods风险之间的关联和结果：PubMed、EMBASE和MEDLINE数据库从开始到2016年6月30日进行了检索，以获得使用者与非使用者NOD风险的队列和病例对照研究，>= 1000例受试者随访>= 1年。两位综述作者评估了研究资格和偏倚风险，并独立进行了数据提取。通过随机效应模型计算汇总估计值，并通过I-2指数检验和测量研究间异质性。此外，还进行了分层分析和发表偏倚评价。最终纳入20项研究，18项队列研究和2项病例对照研究。总体而言，他汀类药物使用者的NOD风险高于非使用者（RR 1.44; 95%CI 1.31-1.58）。高研究间异质性（I-2 = 97%）被发现。所有单一他汀类药物的估计值显示了类效应，从瑞舒伐他汀（RR 1.61; 1.30-1.98）到辛伐他汀（RR 1.38; 1.19-1.61）。结论：本荟萃分析证实并加强了他汀类药物使用致糖尿病效应的证据。这些观察结果证实，需要对服用他汀类药物的患者进行严格监测，特别是糖尿病前期患者或存在糖尿病风险因素的患者。(C)2017年意大利糖尿病学会，意大利动脉粥样硬化研究学会，意大利人类营养学会，以及Federico II大学临床医学和外科学系。Elsevier B. V.出版，保留所有权利。
Background and aims: Meta-analyses of randomized control trials investigating the association between incident diabetes and statin use showed an increased risk of new-onset diabetes (NOD) from 9% to 13% associated with statins. However, short follow-up period, unpowered sample size, and lack of pre-specified diagnostic criteria for diabetes detection could be responsible of an underestimation of this risk. We conducted a meta-analysis of published observational studies to evaluate the association between statins use and risk of NOD.Methods and results: PubMed, EMBASE and MEDLINE databases were searched from inception to June 30, 2016 for cohort and case-control studies with risk of NOD in users vs nonusers, on >= 1000 subjects followed-up for >= 1 year. Two review authors assessed study eligibility and risk of bias and undertook data extraction independently. Pooled estimates were calculated by a random-effects model and between-study heterogeneity was tested and measured by I-2 index. Furthermore, stratified analyses and the evaluation of publication bias were performed. Finally, the meta-analysis included 20 studies, 18 cohort and 2 case-control studies. Overall, NOD risk was higher in statin users than nonusers (RR 1.44; 95% CI 1.31-1.58). High between-study heterogeneity (I-2 = 97%) was found. Estimates for all single statins showed a class effect, from rosuvastatin (RR 1.61; 1.30-1.98) to simvastatin (RR 1.38; 1.19-1.61).Conclusions: The present meta-analysis confirms and reinforces the evidence of a diabetogenic effect by statins utilization. These observations confirm the need of a rigorous monitoring of patients taking statins, in particular pre-diabetic patients or patients presenting with established risk factors for diabetes. (C) 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.