Statin Therapy is Associated with Higher Risk of Diabetic Complications: A Population-Based Cohort Study

Abstract

BackgroundData regarding diabetic complications with chronic statin use among Asian population is very limited. Hence, we investigated diabetic progression in diabetic patients receiving statin therapy by evaluating the association with acute and chronic diabetic complications. MethodsThis retrospective population-based cohort study included patients aged 40 years or older who were diagnosed with type-2 diabetes mellitus (T2DM) in Hong Kong between January 1st, 2009 and December 31st, 2009 and followed up till December 31st, 2019. Patients were divided into statin users and non-users, and propensity score matching (PSM) was performed based on demographics, prior comorbidities, and medications. The study outcomes were new-onset Diabetic Ketoacidosis/ Hyperosmolar Hyperglycaemic State (DKA/HHS), new diabetic ophthalmological, neurological, and renal complications. ResultsAfter 1:1 PSM, the study cohort consisted of 3,247 statin users (48.6% male, age 65.03±11.99 years, mean follow-up 5.68±2.39 years) and 3,247 (50.5% male, age 63.20±12.15 years, mean follow-up 5.78±2.34 years) matched statin non-users. Cox proportional hazards model analyses showed that statin therapy was associated with a higher risk of new diabetic renal complications (HR: 1.44, [1.21-1.71], p<0.001), new diabetic ophthalmological complications (HR: 1.44, [1.19-1.73], p<0.001), and new diabetic neurological complications (HR: 1.47, [1.09-1.96], p<0.01), although it was not associated with a higher risk of DKA/HHS (HR: 1.31, [95% CI, 0.89-1.94], p=0.167). The statistical significance of the associations was not maintained under sensitivity analysis which involved excluding patients with previous coronary heart disease. ConclusionAmongst T2DM patients, statin use was associated with higher risk of developing chronic diabetic complications after PSM with multiple adjustments.