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Risk of incident diabetes among patients treated with statins: population based study

BMJ 2013; 346 doi: (Published 23 May 2013) Cite this as: BMJ 2013;346:f2610
  1. Aleesa A Carter, pharmacist, pharmD12,
  2. Tara Gomes, assistant professor, scientist234,
  3. Ximena Camacho, epidemiologist3,
  4. David N Juurlink, scientist, associate professor3567,
  5. Baiju R Shah, scientist, associate professor3567,
  6. Muhammad M Mamdani, professor, scientist23468
  1. 1Toronto General Hospital, Toronto, ON, Canada M5G 2C4
  2. 2Leslie Dan Faculty of Pharmacy, Toronto, ON, Canada, M5S 3M2
  3. 3Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, M4N 3M5
  4. 4Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada, M5B 1W8
  5. 5Department of Medicine, Kings College Circle, Toronto, ON, Canada, M5S 1A8
  6. 6Department of Health Policy, Management and Evaluation University of Toronto, 155 Toronto, ON, Canada, M5T 3M6
  7. 7Sunnybrook Research Institute, Toronto, ON, Canada, M4N 3M5
  8. 8Department of Medicine, St Michael’s Hospital, Toronto, ON, Canada, M5B 1W8
  1. Correspondence to: M M Mamdani mamdanim{at}
  • Accepted 28 March 2013


Objective To examine the risk of new onset diabetes among patients treated with different HMG-CoA reductase inhibitors (statins).

Design Population based cohort study with time to event analyses to estimate the relation between use of particular statins and incident diabetes. Hazard ratios were calculated to determine the effect of dose and type of statin on the risk of incident diabetes.

Setting Ontario, Canada.

Participants All patients aged 66 or older without diabetes who started treatment with statins from 1 August 1997 to 31 March 2010. The analysis was restricted to new users who had not been prescribed a statin in at least the preceding year. Patients with established diabetes before the start of treatment were excluded.

Interventions Treatment with statins.

Main outcome measure Incident diabetes.

Results Compared with pravastatin (the reference drug in all analyses), there was an increased risk of incident diabetes with atorvastatin (adjusted hazard ratio 1.22, 95% confidence interval 1.15 to 1.29), rosuvastatin (1.18, 1.10 to 1.26), and simvastatin (1.10, 1.04 to 1.17). There was no significantly increased risk among people who received fluvastatin (0.95, 0.81 to 1.11) or lovastatin (0.99, 0.86 to 1.14). The absolute risk for incident diabetes was about 31 and 34 events per 1000 person years for atorvastatin and rosuvastatin, respectively. There was a slightly lower absolute risk with simvastatin (26 outcomes per 1000 person years) compared with pravastatin (23 outcomes per 1000 person years). Our findings were consistent regardless of whether statins were used for primary or secondary prevention of cardiovascular disease. Although similar results were observed when statins were grouped by potency, the risk of incident diabetes associated with use of rosuvastatin became non-significant (adjusted hazard ratio 1.01, 0.94 to 1.09) when dose was taken into account.

Conclusions Compared with pravastatin, treatment with higher potency statins, especially atorvastatin and simvastatin, might be associated with an increased risk of new onset diabetes.


  • We thank Brogan, Ottawa, for use of their Drug Product and Therapeutic Class Database.

  • Contributors: AAC, TG, XC, and MMM were responsible for conception and design. All authors analyzed and interpreted data and drafted and revised the article. XC is guarantor.

  • Funding: This study was supported by a grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC) Drug Innovation Fund and the Institute for Clinical Evaluative Sciences (ICES), a non-profit research institute sponsored by the Ontario MOHLTC.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare that MMM has received honoraria from Boehringer Ingelheim, Sanofi-Aventis, Lilly, Pfizer, Bristol-Myers Squibb, Merck and Bayer.

  • Ethical approval: The research ethics board of Sunnybrook Health Sciences Centre approved this study.

  • Data sharing: No additional data available.

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