Effects of statin medication on mortality risk associated with type 2 diabetes in older persons: the population-based AGES-Reykjavik Study

Abstract

ObjectiveTo examine if the beneficial effect of statin medication on mortality seen in randomised clinical trials of type 2 diabetes applies equally to observational studies in the general population of older people.DesignA prospective, population-based cohort study.SettingReykjavik, Iceland.Participants5152 men and women from the Age, Gene/Environment Susceptibility-Reykjavik Study, mean age 77 years, range of 66–96 years.Main outcome measureCardiovascular and all-cause mortalities and the RR of dying according to statin use and history of coronary heart disease (CHD) in persons with type 2 diabetes and those without diabetes with a median follow-up time of 5.3 years, until end of 2009.ResultsThe prevalence of type 2 diabetes was 12.4% of which 35% used statins. Statin use was associated with a 50% (95% CI 8% to 72%) lower cardiovascular mortality and 53% (29% to 68%) lower all-cause mortalities in persons with diabetes. For those without diabetes, statin use was associated with a 16% (−24% to 43%) lower cardiovascular and 30% (11% to 46%) lower all-cause mortalities. Persons with diabetes using statins had a comparable risk of cardiovascular and all-cause mortality to that of the general population without diabetes. The effect was independent of the level of glycaemic control.ConclusionThis observational study lends important support to existing data from randomised clinical trials. These data suggest that in the general population of older people with diabetes, statin medication markedly reduces the excess cardiovascular and all-cause mortality risk, irrespective of the presence or absence of coronary heart disease or glucose-lowering medication.

Changes in total cholesterol levels in Western societies are not related to statin, but rather dietary factors: the example of the Icelandic population

“…The fall in TC by statin use is also shown in Figure 2A and B. The trend for individuals not using statins is almost superimposable on the population This demonstrates again that although statin use is highly effective in treating individual cholesterol levels and with very beneficial effect on outcome (for example, increased survival in diabetic patients treated with statins, recently demonstrated in the same population 19 ) they are not the main driver of population change in TC neither in males nor females.…”

Epidemiological studies of CHD and the evolution of preventive cardiology

“…51 In another report, those with diabetes who were receiving statins had a 50% lower cardiovascular mortality than those not taking statins. 52 The PROCAM study The Prospective Cardiovascular Munster (PROCAM) study 53 32 The graph shows the association between total cholesterol and total mortality within a country, or region within the country. Each point represents a single centre.…”

Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study

“…Those with longstanding diabetes have a risk of coronary heart disease similar to that of patients with a history of coronary heart disease 13. Still, the benefit of statins in primary prevention in older people with diabetes has not been sufficiently evaluated 14. Notwithstanding this uncertainty, the number of prescriptions for statins in those aged 75 years or older have increased in recent decades 1516.…”