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Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative
Annie L. Culver, BPharm;
Ira S. Ockene, MD;
Raji Balasubramanian, ScD;
Barbara C. Olendzki, RD, MPH;
Deidre M. Sepavich, MBA;
Jean Wactawski-Wende, PhD;
JoAnn E. Manson, MD, DrPH;
Yongxia Qiao, MD;
Simin Liu, MD, ScD;
Philip A. Merriam, MSPH;
Catherine Rahilly-Tierny, MD, MPH;
Fridtjof Thomas, PhD;
Jeffrey S. Berger, MD, MS;
Judith K. Ockene, PhD, MEd, MA;
J. David Curb, MD;
Yunsheng Ma, MD, PhD
Arch Intern Med. Published online January 9, 2012. doi:10.1001/archinternmed.2011.625
Background This study investigates whether the incidence of new-onset diabetes mellitus (DM) is associated with statin use among postmenopausal women participating in the Women's Health Initiative (WHI).
Methods The WHI recruited 161 808 postmenopausal women aged 50 to 79 years at 40 clinical centers across the United States from 1993 to 1998 with ongoing follow-up. The current analysis includes data through 2005. Statin use was captured at enrollment and year 3. Incident DM status was determined annually from enrollment. Cox proportional hazards models were used to estimate the risk of DM by statin use, with adjustments for propensity score and other potential confounding factors. Subgroup analyses by race/ethnicity, obesity status, and age group were conducted to uncover effect modification.
Results This investigation included 153 840 women without DM and no missing data at baseline. At baseline, 7.04% reported taking statin medication. There were 10 242 incident cases of self-reported DM over 1 004 466 person-years of follow-up. Statin use at baseline was associated with an increased risk of DM (hazard ratio [HR], 1.71; 95% CI, 1.61-1.83). This association remained after adjusting for other potential confounders (multivariate-adjusted HR, 1.48; 95% CI, 1.38-1.59) and was observed for all types of statin medications. Subset analyses evaluating the association of self-reported DM with longitudinal measures of statin use in 125 575 women confirmed these findings.
Conclusions Statin medication use in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population.
Author Affiliations: Rochester Methodist Hospital, Mayo Clinic, Rochester, Minnesota (Ms Culver); Divisions of Cardiovascular Medicine (Dr I. S. Ockene) and Preventive and Behavioral Medicine (Mss Olendzki and Sepavich, Drs Qiao, J. K. Ockene, and Ma, and Mr Merriam), Department of Medicine, University of Massachusetts Medical School, Worcester; Division of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (Dr Balasubramanian); Department of Social and Preventive Medicine, University of Buffalo, Buffalo, New York (Dr Wactawski-Wende); Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Manson); Department of Preventive Medicine, Tongji University School of Medicine, Shanghai, China (Dr Qiao); Departments of Medicine and Epidemiology, University of California, Los Angeles, School of Public Health and David Geffen School of Medicine, Los Angeles (Dr Liu); Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston (Dr Rahilly-Tierny); Division of Aging, Department of Medicine, Brigham and Women's Hospital, Chestnut Hill, Massachusetts (Dr Rahilly-Tierny); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (Dr Thomas); Division of Cardiology, Department of Medicine, New York University Medical Center, New York (Dr Berger); and Department of Geriatric Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu (Dr Curb).
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