Because findings from previous observational studies of statin use in retrospective studies and in large cohort studies were inconsistent with those reported in large randomized, controlled trials, researchers sought to determine the real-world risk for new-onset diabetes (NOD) in patients being seen by healthcare providers in the Midwest who had indications for statin use.

Lead author Victoria Zigmont, PhD, MPH, assistant professor of public health at Southern Connecticut State University in New Haven, and colleagues at Ohio State University explored the relationship between statin use and glycemic control to provide data to better inform clinical judgment and future treatment. The team reviewed the insurance records of roughly 7,000 individuals with cardiovascular disease risk factors or who had experienced a cardiovascular event. 

Since the study objective was to assess the likelihood of developing diabetes after the initiation of statins, the study excluded anyone who was diagnosed at the time the study began or within 90 days of being enrolled in the study. The selection process resulted in over 4,500 patients being included in the final analyses. The researchers used logistic regression with inverse probability weighting to compare incident statin users and nonusers. Using Cox proportional hazards models with varying times from statin use to NOD, the researchers evaluated the risk of elevated glycosylated hemoglobin (HbA1c; >6%) and NOD development and diagnosis. 

The team reported that statin users had a higher risk of developing NOD (average hazard ratio [AHR] = 2.20; 95% CI, 1.35, 3.58, P = .002) and that there was a higher prevalence of elevated HbA1c (probability distribution [PD] = .065; 95% CI, 0.002, 0.129, P = .045) among nondiabetic incident users of statins. Although they did not evaluate the specific statin or dose used, the team did consider these factors and were able to determine that the lipophilic (high-intensity) statins did not pose a greater risk. The greatest risk of developing NOD was determined to be the treatment duration of 2 years or longer (AHR = 3.33; 95% CI, 1.84, 6.01, P <.001).  Although treatment duration emerged as the greatest risk, the team underscored the importance of statin use to decrease the risk of cardiovascular disease. 

“It could be that there are individual risk factors may precipitate developing diabetes that haven’t been discovered yet,” said Dr. Zigmont, who went on to say, “There has been some discussion about a possible mechanism by which statins increase insulin resistance”; however, the answer remains elusive, so more study is required. However, “it is important to take cholesterol-lowering medication when your doctor prescribes it because you have a higher risk of cardiovascular disease.”

The authors concluded that as lifestyle programs are promoted in primary care settings, “we hope physicians will integrate and insurers support healthy lifestyle strategies as part of the optimal management of individuals at risk for both NOD and cardiovascular disease.” 

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