Higher potency statins and the risk of new diabetes: multicentre, observational study of administrative databases

ObjectiveTo evaluate the incremental increase in new onset diabetes from higher potency statins compared with lower potency statins when used for secondary prevention.DesignEight population based cohort studies and a meta-analysis.SettingSix Canadian provinces and two international databases from the UK and US.Participants136 966 patients aged ≥40 years newly treated with statins between 1 January 1997 and 31 March 2011.MethodsWithin each cohort of patients newly prescribed a statin after hospitalisation for a major cardiovascular event or procedure, we performed as-treated, nested case-control analyses to compare diabetes incidence in users of higher potency statins with incidence in users of lower potency statins. Rate ratios of new diabetes events were estimated using conditional logistic regression on different lengths of exposure to higher potency versus lower potency statins; adjustment for confounding was achieved using high dimensional propensity scores. Meta-analytic methods were used to estimate overall effects across sites.Main outcome measuresHospitalisation for new onset diabetes, or a prescription for insulin or an oral antidiabetic drug.ResultsIn the first two years of regular statin use, we observed a significant increase in the risk of new onset diabetes with higher potency statins compared with lower potency agents (rate ratio 1.15, 95% confidence interval 1.05 to 1.26). The risk increase seemed to be highest in the first four months of use (rate ratio 1.26, 1.07 to 1.47).ConclusionsHigher potency statin use is associated with a moderate increase in the risk of new onset diabetes compared with lower potency statins in patients treated for secondary prevention of cardiovascular disease. Clinicians should consider this risk when prescribing higher potency statins in secondary prevention patients.