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Hypertensive patients are at increased risk of developing diabetes mellitus (DM). New DM has been associated with statin use in randomized control trials and post-menopausal women, but the relationship of DM to statin therapy over relatively short-term follow-up in hypertensive patients during aggressive blood pressure reduction is unclear.
Incident DM was examined in relation to baseline and in-treatment statin therapy prior to development of DM in 7,001 hypertensive patients with ECG left ventricular hypertrophy (LVH) without DM randomly assigned to losartan- or atenolol-based treatment. Analysis was restricted to new DM occurring ≥2 years after study enrolment due to the small number of patients on a statin at baseline (n=504, 7.2%); however 23.7% took a statin at some time during follow-up.
During 4.9±0.7 years follow-up, new DM developed at year-2 or later in 311 patients (4.4%). In univariate Cox analyses, in-treatment statin use treated as a time-varying covariate was associated with a 74% higher risk of new DM (HR 1.74, 95% CI 1.37-2.20). In contrast, baseline statin use was not a significant predictor of incident DM (HR 1.33, 95% CI 0.90-1.96). In multivariate Cox analyses adjusting for randomized treatment, baseline age, sex, race, prior antihypertensive therapy, history of ischemic heart disease, myocardial infarction, heart failure or peripheral vascular disease, baseline serum glucose, creatinine and uric acid and a logistic propensity score for statin use treated as standard covariates, and in-treatment Cornell product LVH, diastolic and systolic pressure, body mass index, hydrochlorothiazide use, HDL and non-HDL cholesterol treated as time-varying covariates, in-treatment statin use remained associated with an 88% increased risk of new DM (HR 1.88, 95% CI 1.45-2.45). Exclusion of patients on a statin at baseline did not dilute the relationship of in-treatment statin therapy to new DM (adjusted HR 2.47, 95% CI 1.83-3.33).
Statin use in hypertensive patients with ECG LVH is strongly associated with increased risk of new DM, even after adjusting for other potential DM risk factors, treatment effects and a propensity score for statin use.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Coronary Risk Factors and Management
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 1115-104
- 2013 American College of Cardiology Foundation