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Open Access Highly Accessed Research article

Statins and the risk of type 2 diabetes mellitus: cohort study using the UK clinical practice pesearch datalink

Ana Filipa Macedo12*, Ian Douglas1, Liam Smeeth1, Harriet Forbes1 and Shah Ebrahim1*

Author Affiliations

1 Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

2 Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal

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BMC Cardiovascular Disorders 2014, 14:85  doi:10.1186/1471-2261-14-85

Published: 15 July 2014

Abstract

Background

There is strong evidence of reductions in major vascular events from statins across all cardiovascular risk categories. However, trials of statin therapy have provided conflicting results regarding statin use and type 2 diabetes (T2DM). We aimed to assess the effect of statins on T2DM development.

Method

We carried out a population-based cohort study using the Clinical Practice Research Datalink (CPRD), a database of computerized clinical records. Every patient aged 30–85 years old starting a statin between 1989 and 2009 was matched with up to five non-statin users. The observation period in CPRD ended in 31 December 2011. Cox proportional hazard regression was used to compare rates of T2DM between statin users and non-users, using propensity score method to adjust for systematic differences between groups.

Results

The study basis comprised 2,016,094 individuals, including 430,890 people who received a statin, matched to 1,585,204 people not prescribed a statin. Mean follow-up time was 5.43 years for statin users and 3.89 years for nonusers. During follow-up 130,395 individuals developed T2DM. Statin use was associated with an increased risk of T2DM (HR 1.57; 95% CI 1.54-1.59), which increases with longer duration of use. The increased risk was smaller among people with hypertension or cardiovascular disease and was only apparent after 5 or more years treatment with statins in these groups. Conversely, age-specific risk ratios decreased in older people.

Conclusions

Statin use is associated with an increased risk of T2DM. Our results suggest that the relative risk is higher among people without diagnosed hypertension or cardiovascular disease. These findings should be considered in the context of the observational nature of the data which is prone to bias and unmeasured confounding.

Keywords:
Statins; Type 2 diabetes; Cardiovascular; Safety; Observational