Abstract 15568: Is the Association of Statin Use and Incident Diabetes Mellitus Still Significant in Primary Prevention Treatment When Accounting for Incident Cardiovascular Events?

Abstract

Background: Statins are first line therapy for hyperlipidemia and the preferred treatment for primary and secondary prevention of cardiovascular disease (CVD). Meta-analyses of prior statin studies suggest an association of statin use with incident diabetes (DM). It is unknown whether incident co-morbid disease plays a role in this observed increase in incident DM amongst statin users. We examined the risk of incident DM using a competing risk of time to first event model. Method: Patients from an integrated health care system were included if they were > 45 years of age, had no prior history of either CVD or DM and who were started on a statin medication for primary prevention. Patients were followed from January 2002 to November 2012 and assessed at 1, 5, and 10 years (n=14736, 10305, and 2541 respectively) for the association of continuous statin use and incident DM or CV event (MI, CVA, AF, CHF, or coronary revascularization). Time until first event was examined using a competing risks statistical model, where the outcome was incident DM a first CV event, or neither. Risk estimates were adjusted using propensity scores of sex, age, hypertension, hyperlipidemia, renal failure, or tobacco use. Results: Patients averaged 55±6 years and were 56% male. Though not statistically significant, 1 -yr follow-up of statin use trended toward an association with incident DM (HR=1.68, 95% CI (0.978, 2.89), p=0.06). 5-yr follow-up of statin use was significantly associated with incident DM (HR=1.48, 95% CI (1.11, 1.97), p =0.008). 10-yr follow-up of statin use was not significantly associated with incident DM (HR=1.01, 95% CI (0.687, 1.47), p =0.97). Conclusion: Using a competing risks model, an association between continuous statin use at 5-years and incident DM was observed, with a trend toward an association at 1-year. Although continuous statin treatment through 5 years was associated with risk of DM , these results do not reveal whether that risk outweighs the expected benefit of statin therapy for primary prevention.