Statins may protect adults with T1DM against all-cause death, CVD

The use of statins for primary prevention in adults with type 1 diabetes mellitus (T1DM) appears to prevent all-cause mortality and major cardiovascular disease (CVD), with an acceptable safety profile, a study has shown.

Using UK primary care data from the IQVIA Medical Research Data database, a team of investigators conducted a sequential target trial emulation comparing statin initiation with noninitiation.

Participants included patients aged 25–84 years with a diagnosis of T1DM who were prescribed insulin from January 2005 to December 2016 and had baseline low-density lipoprotein cholesterol (LDL-C) ≥2.6 mmol/L (100 mg/dL) or nonhigh-density lipoprotein cholesterol ≥3.4 mmol/L (130 mg/dL).

All-cause mortality, major CVD, and adverse events (ie, myopathy and liver dysfunction) were the main outcome measures. The investigators estimated with 10-year absolute risk differences (RDs) for the observational analogues of the intention-to-treat (ITT) and per-protocol (PP) effects.

A total of 4,176 statin initiators (mean age 45 years, 40.6 percent female) were included in the analysis, as well as 16,704 noninitiator person-trials, with a median follow-up of 6 years.

Statin initiation, compared with noninitiation, resulted in lower risks of all-cause mortality (ITT: RD, –1.66 percent, 95 percent confidence interval [CI], –2.79 to –0.45; PP: RD, –3.48 percent, 95 percent CI, –4.68 to –2.07) and major CVD (ITT: RD, –1.63 percent, 95 percent CI, –2.57 to –0.53; PP: RD, –2.69 percent, 95 percent CI, –4.00 to –1.22).

In some analyses, a slight association with an increased risk of liver dysfunction was noted, but no association with myopathy was seen. Notably, subgroup analyses revealed a generally larger absolute risk reductions among women, persons aged ≥40 years, persons with baseline LDL-C ≥3.4 mmol/L (130 mg/dL), and those with a higher predicted cardiovascular risk.

“The differences in absolute risk reductions can help guide personalized statin treatment decisions in T1DM,” the investigators said.