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. 2023 Mar 29;16(4):507.
doi: 10.3390/ph16040507.

Effects of Statin Dose, Class, and Use Intensity on All-Cause Mortality in Patients with Type 2 Diabetes Mellitus

Jung-Min Yu  1   2 , Wan-Ming Chen  3   4 , Mingchih Chen  3   4 , Ben-Chang Shia  3   4 , Szu-Yuan Wu  3   4   5   6   7   8   9   10   11
Affiliations

Effects of Statin Dose, Class, and Use Intensity on All-Cause Mortality in Patients with Type 2 Diabetes Mellitus

Jung-Min Yu et al. Pharmaceuticals (Basel). .

Abstract

Purpose: to examine the impact of statins on reducing all-cause mortality among individuals diagnosed with type 2 diabetes. This investigation explored the potential correlations between dosage, drug classification, and usage intensity with the observed outcomes.

Methods: The research sample consisted of individuals aged 40 years or older diagnosed with type 2 diabetes. Statin usage was determined as a frequent usage over a minimum of one month subsequent to type 2 diabetes diagnosis, where the average statin dose was ≥28 cumulative defined daily doses per year (cDDD-year). The analysis employed an inverse probability of treatment-weighted Cox hazard model, utilizing statin usage status as a time-varying variable, to evaluate the impact of statin use on all-cause mortality.

Results: The incidence of mortality was comparatively lower among the cohort of statin users (n = 50,804 (12.03%)), in contrast to nonusers (n = 118,765 (27.79%)). After adjustments, the hazard ratio (aHR; 95% confidence interval (CI)) for all-cause mortality was estimated to be 0.32 (0.31-0.33). Compared with nonusers, pitavastatin, rosuvastatin, pravastatin, simvastatin, atorvastatin, fluvastatin, and lovastatin users demonstrated significant reductions in all-cause mortality (aHRs (95% CIs) = 0.06 (0.04-0.09), 0.28 (0.27-0.29), 0.29 (0.28-0.31), 0.31 (0.30-0.32), 0.31 (0.30-0.32), 0.36 (0.35-0.38), and 0.48 (0.47-0.50), respectively). In Q1, Q2, Q3, and Q4 of cDDD-year, our multivariate analysis demonstrated significant reductions in all-cause mortality (aHRs (95% CIs) = 0.51 (0.5-0.52), 0.36 (0.35-0.37), 0.24 (0.23-0.25), and 0.13 (0.13-0.14), respectively; p for trend <0.0001). Because it had the lowest aHR (0.32), 0.86 DDD of statin was considered optimal.

Conclusions: In patients diagnosed with type 2 diabetes, consistent utilization of statins (≥28 cumulative defined daily doses per year) was shown to have a beneficial effect on all-cause mortality. Moreover, the risk of all-cause mortality decreased as the cumulative defined daily dose per year of statin increased.

Keywords: class of statin; dose-dependent; mortality; statin; type 2 diabetes.

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Conflict of interest statement

The authors have no potential conflict of interest to declare. The data sets supporting the study conclusions are included in the manuscript.

Figures

Figure 1
Figure 1
Kaplan–Meier overall survival curves of patients with type 2 diabetes who used different classes of statins.
Figure 2
Figure 2
Kaplan–Meier overall survival curves of patients with type 2 diabetes who used different cDDD-year of statins.
Figure 3
Figure 3
DDD of statin use vs. HRs for all-cause mortality.
Figure 4
Figure 4
Kaplan–Meier overall survival curves of patients with type 2 diabetes who used and did not use statins.
See this image and copyright information in PMC

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References

    1. GBD 2015 Risk Factors Collaborators Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–1724. doi: 10.1016/S0140-6736(16)31679-8. - DOI - PMC - PubMed
    1. Chatterjee S., Khunti K., Davies M.J. Type 2 diabetes. Lancet. 2017;389:2239–2251. doi: 10.1016/S0140-6736(17)30058-2. - DOI - PubMed
    1. DeFronzo R.A., Ferrannini E. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care. 1991;14:173–194. doi: 10.2337/diacare.14.3.173. - DOI - PubMed
    1. Alberti K.G., Eckel R.H., Grundy S.M., Zimmet P.Z., Cleeman J.I., Donato K.A., Fruchart J.C., James W.P., Loria C.M., Smith S.C., Jr., et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–1645. doi: 10.1161/CIRCULATIONAHA.109.192644. - DOI - PubMed
    1. Phillips D.I., Barker D.J., Hales C.N., Hirst S., Osmond C. Thinness at birth and insulin resistance in adult life. Diabetologia. 1994;37:150–154. doi: 10.1007/s001250050086. - DOI - PubMed

Grants and funding

Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, supports Szu-Yuan Wu’s work (Funding Number: 10908, 10909, 11001, 11002, 11003, 11006, and 11013).
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