Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea.
Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
PLoS One. 2018 Apr 9;13(4):e0195459. doi: 10.1371/journal.pone.0195459. eCollection 2018.
Statins have been known to increase the risk of incident type 2 diabetes mellitus (DM); however, other factors, especially hypertension, are also associated with DM development.
We investigated whether statin use increases the risk of DM and further analyzed whether the relation between statin use and incident DM differs according to the presence of hypertension and gender.
From a nationwide health-screening cohort, 40,164 participants with total cholesterol levels ≥eve mg/dL and without pre-diagnosed DM, cardiovascular disease, or cancer, who underwent a series of regular health check-ups, were enrolled. Statin users were defined as participants who were prescribed statins more than twice during 6 months.
There were 17,798 statin non-users and 22,366 statin users. During 7.66±3.21 years of follow-up, incident DM developed in 5.68% of statin non-users and 7.64% of statin users. Among the entire study population, statin use was associated with new-onset DM after adjusting for clinical risk factors. In sub-analysis according to hypertension, statin use significantly increased the risk of incident DM only in normotensive patients [hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.09 to 1.58, p = 0.004], and not in hypertensive patients (p>0.05). Furthermore, continuous statin use was strongly associated with new-onset DM in women, regardless of hypertension presence (all p<0.05). However, in men, statin was associated with new-onset DM only in normotensive males (HR 1.61, 95% CI 1.35 to 1.92, p<0.001) and not in hypertensive males (p>0.05).
Statin use increased the risk of new-onset DM only in normotensive patients and hypertensive women, suggesting that these groups should be more carefully monitored for the development of DM during the course of follow-up.
他汀类药物已被证实会增加 2 型糖尿病（DM）的发病风险；然而，其他因素，尤其是高血压，也与 DM 的发生有关。
我们旨在探究他汀类药物的使用是否会增加 DM 的发病风险，并进一步分析在考虑到高血压和性别因素的情况下，他汀类药物的使用与新发 DM 之间的关系是否存在差异。
我们从一项全国性的健康筛查队列中纳入了 40164 名总胆固醇水平≥240mg/dL 且无糖尿病、心血管疾病或癌症病史的参与者，这些参与者接受了一系列定期健康检查。他汀类药物使用者被定义为在 6 个月内接受他汀类药物处方超过两次的参与者。
在随访 7.66±3.21 年后，17798 名他汀类药物未使用者和 22366 名他汀类药物使用者中分别有 5.68%和 7.64%发生了新发 DM。在校正了临床危险因素后，在整个研究人群中，他汀类药物的使用与新发 DM 相关。在根据高血压进行的亚组分析中，他汀类药物的使用仅在血压正常的患者中显著增加了新发 DM 的风险[风险比（HR）1.31，95%置信区间（CI）1.09 至 1.58，p=0.004]，而在高血压患者中则没有（p>0.05）。此外，无论高血压的存在与否，女性持续使用他汀类药物与新发 DM 均有强烈关联（均 p<0.05）。然而，在男性中，他汀类药物仅与血压正常的男性新发 DM 相关（HR 1.61，95%CI 1.35 至 1.92，p<0.001），而与高血压男性无关（p>0.05）。
他汀类药物的使用仅在血压正常的患者和高血压女性中增加了新发 DM 的风险，提示在随访过程中应更密切监测这些人群 DM 的发生。
