Statins use and risk of new-onset diabetes in hypertensive patients: a population-based retrospective cohort study in Yinzhou district, Ningbo city, People’s Republic of China

Figures & data

Figure 1 Flow chart of the study population.

Figure 2 Histograms of the density of propensity scores for cohort before and after matching.

Table 1 Baseline characteristics of the original and matched cohorts of hypertensive patients without history of diabetes

Characteristics	Overall patients			Matched patients
	Non-statin	Statin	P-value	Non-statin	Statin	P-value
N (%)	46,442 (100)	21,551 (100)		19,819 (100)	19,819 (100)
Age
Mean ± SD	58.87 (13.0)	61.48 (11.2)	<0.001	61.93 (12.8)	61.40 (11.2)	<0.001
Median (Q1–Q3)	58.00 (49–67)	61.00 (54–69)		61.00 (53–72)	61.00 (54–69)
Sex (female)	24,487 (52.7)	11,989 (55.6)	<0.001	11,065 (55.8)	10,990 (55.5)	0.992
Dyslipidemia	1,085 (2.3)	2,734 (12.7)	<0.001	1,084 (5.5)	1,099 (5.5)	0.982
MI	13 (0.0)	28 (0.1)	<0.001	11 (0.1)	8 (0.0)	0.522
CAD	1,353 (2.9)	1,210 (5.6)	<0.001	582 (2.9)	630 (3.2)	0.385
CVA	428 (0.9)	518 (2.4)	<0.001	247 (1.2)	253 (1.3)	0.818
Heart failure	437 (0.9)	418 (1.9)	<0.001	215 (1.1)	227 (1.1)	0.995
Angina pectoris	407 (0.9)	489 (2.3)	<0.001	227 (1.1)	219 (1.1)	0.257
BMI, kg/m^2
Mean ± SD	23.34 (4.26)	23.85 (5.92)	<0.001	23.71 (5.28)	23.79 (4.00)	0.090
Median (Q1–Q3)	23.10 (21.50–24.90)	23.50 (21.80–25.50)		23.50 (21.60–25.40)	23.50 (21.80–25.50)
BMI, kg/m^2			<0.001			0.811
<24	29,305 (63.1)	12,029 (55.8)		11,071 (55.9)	11,150 (56.3)
24–28	14,345 (30.9)	7,642 (35.5)		7,086 (35.8)	6,989 (35.3)
≥28	2,792 (6.0)	1,880 (8.7)		1,662 (8.4)	1,680 (8.5)
Cigarette smoking			<0.001			0.421
Never	34,918 (75.2)	16,302 (75.6)		15,026 (75.8)	15,003 (75.7)
Past	4,156 (8.9)	2,268 (10.5)		2,129 (10.7)	2,068 (10.4)
Current	7,368 (15.9)	2,981 (13.8)		2,664 (13.4)	2,748 (13.9)
Alcohol consumption			0.024			0.952
Never	36,328 (78.2)	16,945 (78.6)		15,576 (78.6)	15,586 (78.6)
Occasional	2,723 (5.9)	1,183 (5.5)		1,064 (5.4)	1,096 (5.5)
Often	7,391 (15.9)	3,423 (15.9)		3,179 (16.0)	3,137 (15.8)
Physical activity			<0.001			0.682
<1 d/wk	20,359 (43.8)	9,796 (45.5)		9,012 (45.5)	8,973 (45.3)
1–4 d/wk	15,475 (33.3)	7,279 (33.8)		6,674 (33.7)	6,690 (33.8)
>4 d/wk	10,608 (22.8)	4,476 (20.8)		4,133 (20.9)	4,156 (21.0)
β blockers	5,995 (12.9)	3,684 (17.1)	<0.001	3,295 (16.6)	3,332 (16.8)	0.989
Diuretics	8,654 (18.6)	4,982 (23.1)	<0.001	4,577 (23.1)	4,523 (22.8)	0.659
ACEI	10,277 (22.1)	5,780 (26.8)	<0.001	5,310 (26.8)	5,244 (26.5)	0.407
ARBs	6,863 (14.8)	4,300 (20.0)	<0.001	3,900 (19.7)	3,934 (19.8)	0.881
CCBs	5,405 (11.6)	3,385 (15.7)	<0.001	3,093 (15.6)	3,098 (15.6)	0.978
Type of statin
Non-statin	46,442 (100.0)	0 (0.0)		19,819 (100.0)	0 (0.0)
Atorvastatin	0 (0.0)	9,263 (43.0)		0 (0.0)	8,516 (43.0)
Fluvastatin	0 (0.0)	170 (0.8)		0 (0.0)	157 (0.8)
Rosuvastatin	0 (0.0)	1,403 (6.5)		0 (0.0)	1,326 (6.7)
Simvastatin	0 (0.0)	10,715 (49.7)		0 (0.0)	9,820 (49.5)

Note: Unless indicated all values in this table are presented as n (%).

Abbreviations: MI, myocardial infarction; CAD, coronary artery disease; CVA, cerebrovascular accident; BMI, body mass index; d, day; wk, week; ACEI, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers; CCBs, calcium channel blockers.

Table 2 Baseline characteristics of patients who developed T2DM

Characteristics	Non-T2DM	T2DM	P-value
N (%)	63,821 (100)	4,172 (100)
Age
Mean ± SD	59.63 (12.63)	60.81 (10.76)	<0.001
Median (Q1–Q3)	59.00 (51–68)	61.00 (54–68)	<0.001
Sex (female)	34,124 (53.5)	2,352 (56.4)	<0.001
Dyslipidemia	3,346 (5.2)	473 (11.3)	<0.001
MI	36 (0.1)	5 (0.1)	0.196
CAD	2,274 (3.6)	289 (6.9)	<0.001
CVAs	834 (1.3)	112 (2.7)	<0.001
Heart failure	758 (1.2)	97 (2.3)	<0.001
Angina pectoris	811 (1.3)	85 (2.0)	<0.001
BMI, kg/m^2
Mean ± SD	23.45 (4.93)	24.30 (3.27)	<0.001
Median (Q1–Q3)	23.20 (21.50–25.10)	24.00 (22.20–26.00)
BMI, kg/m^2			<0.001
<24	39,283 (61.6)	2,051 (49.2)
24–28	4,173 (6.5)	499 (12.0)
≥28	20,365 (31.9)	1,622 (38.9)
Cigarette smoking			<0.001
Never	48,064 (75.3)	3,156 (75.6)
Past	5,946 (9.3)	478 (11.5)
Current	9,811 (15.4)	538 (12.9)
Alcohol consumption			0.359
Never	50,039 (78.4)	3,234 (77.5)
Occasional	3,651 (5.7)	255 (6.1)
Often	10,131 (15.9)	683 (16.4)
Physical activity			<0.001
<1 d/wk	28,137 (44.1)	2,018 (48.4)
1–4 d/wk	21,338 (33.4)	1,416 (33.9)
>4 d/wk	14,346 (22.5)	738 (17.7)
β blockers	9,101 (14.3)	578 (13.9)	0.481
Diuretics	12,727 (19.9)	909 (21.8)	0.004
ACEI	14,959 (23.4)	1,098 (26.3)	<0.001
ARBs	10,344 (16.2)	819 (19.6)	<0.001
CCBs	8,163 (12.8)	627 (15.0)	<0.001
Type of statin			<0.001
Non-statin	44,226 (69.3)	2,216 (53.1)
Atorvastatin	8,553 (13.4)	710 (17.0)
Fluvastatin	153 (0.2)	17 (0.4)
Rosuvastatin	1,321 (2.1)	82 (2.0)
Simvastatin	9,568 (15.0)	1,147 (27.5)

Note: Unless indicated all values in this table are presented as n (%).

Abbreviations: T2DM, type 2 diabetes mellitus; MI, myocardial infarction; CAD, coronary artery disease; CVAs, cerebrovascular accidents; BMI, body mass index; d, day; wk, week; ACEI, angiotensin-converting enzyme inhibitors; ARBs, angiotensin receptor blockers; CCBs, calcium channel blockers.

Figure 3 Cumulative incidence of NOD between new users of statin and non-statin users during the follow-up period.

Abbreviations: NOD, new-onset of diabetes mellitus; grp, group.

Table 3 Incidence rates of NOD by statin exposure status

Group	Number of patients	Number of outcome	Total person-years	Incidence outcome per 1,000 PYs	Adjusted HR (95%)
NOD after 180 days
Non	46,442	1,884	132,767.5	14.19	1.55 (1.44–1.66)
Statin	21,551	1,537	59,848.48	25.68
Non (matched)	19,818	917	56,445.33	16.25	1.54 (1.41–1.67)
Statin (matched)	19,818	1,334	55,237.63	24.15
All NOD
Non	46,442	2,216	132,767.5	16.69	1.75 (1.64–1.87)
Statin	21,551	1,956	59,848.48	32.68
Non (matched)	19,818	1,079	56,445.33	19.06	1.65 (1.53–1.78)
Statin (matched)	19,818	1,729	55,237.63	31.31

Abbreviations: NOD, now onset of diabetes mellitus; HR, hazard ratio.

Table 4 Risk for incident NOD by statin use, within sex, age, BMI, smoke status, alcohol use, exercise frequency, statin types, and potency subgroups

Subgroups	N (%)	Unadjusted HR (95% CI)	Adjusted HR (95% CI)		P-value
Sex
Male	31,517 (46.35)	1.86 (1.68–2.06)	1.58(1.42–1.77)		<0.0001
Female	36,476 (53.65)	1.78 (1.62–1.94)	1.52 (1.38–1.67)		<0.0001
Age
≤49	15,404 (22.66)	2.39 (2.00–2.84)	1.90 (1.58–2.29)		<0.0001
50–59	19,618 (28.85)	1.88 (1.66–2.12)	1.64 (1.45–1.87)		<0.0001
60–69	17,400 (25.59)	1.43 (1.27–1.60)	1.28 (1.13–1.45)		<0.0001
≥70	15,571 (22.90)	1.70 (1.47–1.96)	1.39 (1.19–1.62)		<0.0001
BMI, kg/m^2
<24	42,371 (62.32)	1.92 (1.75–2.12)	1.65 (1.50–1.83)		<0.0001
24–28	21,245 (31.25)	1.59 (1.42–1.77)	1.43 (1.27–1.60)		<0.0001
≥28	4,377 (6.44)	1.53(1.26–1.86)	1.44 (1.17–1.77)		<0.0001
Cigarette smoking
Never	51,220 (75.33)	1.77 (1.64–1.92)	1.57 (1.44–1.70)		<0.0001
Past	6,424 (9.45)	1.67 (1.37–2.04)	1.56 (1.27–1.93)		<0.0001
Current	10,349 (15.22)	2.16 (1.79–2.60)	1.79 (1.46–2.18)		<0.0001
Alcohol consumption
Never	53,273 (78.35)	1.82 (1.68–1.96)	1.60 (1.48–1.73)		<0.0001
Occasional	3,906 (5.74)	2.05 (1.55–2.71)	1.70 (1.26–2.29)		<0.0001
Often	10,814 (15.90)	1.76 (1.49–2.09)	1.57 (1.31–1.87)		<0.0001
Physical activity
<1 d/wk	30,155 (44.35)	1.99 (1.70–2.35)	1.71 (1.44–2.03)		<0.0001
1–4 d/wk	22,754 (33.47)	1.83 (1.63–2.05)	1.66 (1.47–1.87)		<0.0001
>4 d/wk	15,084 (22.18)	1.73 (1.57–1.91)	1.54 (1.39–1.71)		<0.0001
Type of statin
Fluvastatin	170 (0.79)	1.57 (0.91–2.70)	1.44 (0.83–2.48)		0.4903
Rosuvastatin	1,403 (6.51)	1.50 (1.15–1.97)	1.47 (1.19–1.83)		0.0004
Simvastatin	10,715 (49.72)	1.85 (1.71–2.00)	1.64 (1.51–1.78)		<0.0001
Atorvastatin	9,263 (42.98)	1.80 (1.64–1.98)	1.52 (1.37–1.68)		<0.0001
Potency of statin
Low	7,450 (34.57)	1.74 (1.57–1.92)	1.44 (1.29–1.61)		0.0042
Moderate	13,976 (64.85)	1.86 (1.72–2.00)	1.65 (1.53–1.79)		<0.0001
High	125 (0.58)	1.00 (0.32–3.10)	1.80 (0.86–2.82)		0.1432

Abbreviations: NOD, new-onset diabetes mellitus; HR, hazard ratio; CI, confidence interval; BMI, body mass index; d, day; wk, week.