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Effects of statin medication on mortality risk associated with type 2 diabetes in older persons: the population-based AGES-Reykjavik Study
  1. Elin Olafsdottir1,2,
  2. Thor Aspelund1,3,
  3. Gunnar Sigurdsson3,4,
  4. Bolli Thorsson1,
  5. Gudny Eiriksdottir1,
  6. Tamara B Harris5,
  7. Lenore J Launer5,
  8. Rafn Benediktsson3,4,
  9. Vilmundur Gudnason1,3
  1. 1Icelandic Heart Association Research Institute, Kopavogur, Iceland
  2. 2Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
  3. 3Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  4. 4Department of Endocrinology and Metabolism, Landspitali University Hospital, Reykjavik, Iceland
  5. 5Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program, National Institute on Ageing, Bethesda, Maryland, USA
  1. Correspondence to Professor Vilmundur Gudnason; v.gudnason{at}hjarta.is

Abstract

Objective To 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.

Design A prospective, population-based cohort study.

Setting Reykjavik, Iceland.

Participants 5152 men and women from the Age, Gene/Environment Susceptibility-Reykjavik Study, mean age 77 years, range of 66–96 years.

Main outcome measure Cardiovascular 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.

Results The 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.

Conclusion This 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.

  • Cohort study
  • type 2 diabetes
  • statins
  • older persons
  • cardiovascular disease mortality
  • AGES-Reykjavik

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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Footnotes

  • To cite: Olafsdottir E, Aspelund T, Sigurdsson G, et al. Effects of statin medication on mortality risk associated with type 2 diabetes in older persons: the population-based AGES-Reykjavik Study. BMJ Open 2011;1:e000132. doi:10.1136/bmjopen-2011-000132

  • Funding This study has been funded by NIH contract N01-AG-1-2100, the NIA Intramural Research Program, Hjartavernd (the Icelandic Heart Association), and Althingi (the Icelandic parliament). The study is approved by the Icelandic National Bioethics Committee, VSN: 00-063. The researchers are indebted to the participants for their willingness to participate in the study.

  • Competing interests None.

  • Patient consent Obtained.

  • Contributors VG had access to all the data and takes full responsibility for the content of this paper. Drafting of the manuscript: EO, TA, RB and VG. Statistical analysis: EO and TA. Data collection and preparation: EO, TA, VG, BT, GE, GS, LJL and TBH. All authors contributed to the interpretation of the results, read and commented on the manuscript, and approved the final version.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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