Anyanwagu U, et al. – Researchers conducted a retrospective cohort study applying a UK primary care database. Following initiation of insulin therapy in patients with Type 2 Diabetes (T2D) in routine care, concurrent use of a statin was associated with less good glycaemic control in the short–term but a much lower risk of major adverse CV events.

Methods

• Researchers designed a retrospective cohort study including a total of 12,725 insulin initiators with T2D applying The Health Improvement Network (THIN) UK database.
• They compared alterations in HbA1c at 6, 12, 24 and 36 months, and the 5–year risk of mortality and (3–point) major adverse cardiovascular events (MACE) between prior users (n = 10,682) and non–users (n = 2043) of statin therapy who were newly commenced on insulin treatment.
• They applied cox proportional hazard models to estimate the hazard ratios of the different outcomes.

Results

• In this analysis, mean age of the cohort was 58.7 ± 14.0 years (51% male) and mean baseline HbA1c was 8.7 ± 1.8%.
• A greater initial reduction in HbA1c was observed following insulin initiation in the non–users of statins compared with the users, which was significant in the short term (-0.34% vs -0.26% at 6 months; mean diff = -0.09%, p = 0.004) but not in the long term: -0.31% versus -0.35% at 3 years (mean diff = 0.05%, p = 0.344). CV events (3–point MACE) were 878 versus 217 in statin users versus non–users (20.7 vs 30.9 per 1000 person–years; adjusted Hazard Ratio (aHR) 1.36 (95% CI 1.15–1.62; p < 0.0001).
• They observed that HbA1c was higher throughout the study duration with all statins relative to non–users of statin therapy (p < 0.05) in a subgroup analysis of individual statins.
• It was noted that aHRs for 3–point MACE for atorvastatin, simvastatin, rosuvastatin and pravastatin were 0.82 (95% CI 0.68–0.98), 0.67 (0.55–0.82), 0.56 (0.39–0.81) and 0.78 (0.60–1.01), respectively.