Impact of incident diabetes on atherosclerotic cardiovascular disease according to statin use history among postmenopausal women

• Type of Material: Article
• Authors: Yunsheng Ma, University of Massachusetts Medical School; Gioia M. Persuitte, University of Massachusetts Medical School; Christopher Andrews, University of Michigan; Kathleen M. Hovey, State University of New York at Buffalo; Michael J. LaMonte, State University of New York at Buffalo; Annie L. Culver, University of Massachusetts Medical School; JoAnn E. Manson, Harvard Medical School; Lawrence Phillips, Emory University; Simin Liu, Brown University; Charles Eaton, Brown University; Lisa W. Martin, George Washington University; Barbara V. Howard, MedStar Research Institute; Raji Balasubramanian, University of Massachusetts Amherst; Chloe E. Bird, RAND Corporation; Ira S. Ockene, Univ Massachusetts; Susan R. Sturgeon, University of Massachusetts Amherst; Judith K. Ockene, University of Massachusetts Medical School; Lesley Tinker, Fred Hutchinson Cancer Research Center; Rami Nassir, University of California Davis; Jacques Rossouw, National Heart, Lung, and Blood Institute
• Language: English
• Date: 2016-08-01
• Publisher: Springer Verlag (Germany)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Springer Science+Business Media Dordrecht 2016
• Final Published Version (URL): http://dx.doi.org/10.1007/s10654-016-0153-7
• Title of Journal or Parent Work: European Journal of Epidemiology
• ISSN: 0393-2990
• Volume: 31
• Issue: 8
• Start Page: 747
• End Page: 761
• Grant/Funding Information: Our investigation also was supported in part by 5R01HL122241-02.; The Women’s Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221.
• Keywords: Drug-related problem; Epidemiology; THERAPY; Life Sciences & Biomedicine; PRIMARY PREVENTION; SELF-REPORTS; Science & Technology; Diabetes; METAANALYSIS; RISK; METABOLIC SYNDROME; 27 RANDOMIZED-TRIALS; HEALTHY EATING INDEX; Public, Environmental & Occupational Health; INDIVIDUAL DATA; DIET QUALITY; Cardiovascular disease
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

To compare impact of incident diabetes on atherosclerotic cardiovascular disease (ASCVD) risk among postmenopausal women according to statin use. Prospective data from 120,499 postmenopausal women without prevalent diabetes or cardiovascular disease at baseline from the Women's Health Initiative were used. Incident diabetes was self-reported annually and defined as treatment with pills or injectable medication for diabetes. Current statin use was determined at enrollment and years 1, 3, 6, 9 and 13.5 in the three clinical trial arms, and at baseline, year 3, and 13.5 for the observational study. The primary outcome was incident ASCVD events, self-reported annually and adjudicated by blinded local and central physicians. Incident diabetes and statin use status were fitted as time-varying covariates in Cox regression models to assess ASCVD risk during an average follow-up of 13.6 years. For those not on statins at the time of diabetes diagnosis, there was a 42 % increased risk of ASCVD [hazard ratio (HR) 1.42, 95 % CI 1.28-1.58] among women with incident diabetes versus those without diabetes. Among women on statins, there was a 39 % increased risk of ASCVD (HR 1.39, 95 % CI 1.12-1.74) in women with incident diabetes versus those without diabetes. The increased ASCVD risk due to diabetes was similar between women before or after initiating statins (P = 0.89). Whether diabetes was diagnosed before or after statin use did not alter the increased risk of ASCVD associated with diabetes. Mitigating the increased incidence of diabetes in statin users could increase the ASCVD benefit-to-risk ratio of statins.