Statin use and its association with all-cause mortality and incident diabetes/prediabetes in African Americans: Findings from the jackson heart study.

Objectives: This study investigates the association between statin use and all-cause mortality, as well as the association between statin use and incident diabetes or prediabetes among African Americans.

Methods: This study is based on the Jackson Heart Study (JHS), a community-based cohort study of African Americans (AAs). The baseline period for JHS was 9/26/2000 to 3/31/2004. The first follow-up period was from 10/1/2005 to 12/21/2008, and the second follow-up period was from 2/26/2009 to 1/31/2013. All study participants who were statin users or non-users at baseline were included in this study. We applied two common propensity score adjustment techniques to analyze the data: propensity score matching (PSM) and the inverse probability of treatment weighting (IPTW) algorithms.

Results: In this cohort there were 510 deaths. The baseline prevalence of statin use was 13.95% (95% CI: 12.91% - 14.98%), while the baseline rate of all-cause mortality was 11.82% (95% CI: 10.87% - 12.82%). In crude analyses, statin users had an 80% higher risk of mortality compared to non-users, with an odds ratio (OR) of 1.80 (95% CI: 1.43 - 2.27). However, after adjusting for confounders using PSM and IPTW, the adjusted ORs for the association between statin use and mortality were 0.77 (95% CI: 0.53 - 1.12) and 0.80 (95% CI: 0.68 - 0.95), respectively. A post hoc power analysis suggested that the matched analysis was underpowered. The incidence of diabetes/ prediabetes was 39.42% (95% CI: 37.39% - 41.45%), with 879 new cases observed. Statin users had a crude odds ratio (OR) of 2.02 (95% CI: 1.52 - 2.67) for developing diabetes/prediabetes compared to non-users. After adjusting for confounding using PSM) and IPTW, the adjusted ORs were 1.84 (95% CI: 1.21-2.81) and 1.82 (95% CI: 1.59-2.08), respectively.

Conclusion: Statin use was associated with a 20% decrease in all-cause mortality but an 80% increased risk of incident diabetes/prediabetes. Clinicians should consider the implications of these findings when prescribing statins to patients in this population.