Statin use for primary prevention in patients with type 2 diabetes: Can it benefit all ages? – A nationwide propensity-matched cohort study

Aims: This study aims to investigate whether statin use is associated with a reduction in CVD and mortality in patients with type 2 diabetes without pre-existing CVD. Methods: A propensity score-matched cohort analysis using retrospective data was created. Statin users received at least a 90-day prescription, and never used statin before initiation of the study. Statin non-users never received statin throughout the study. Primary outcome was a composite of myocardial infarction (MI), stroke, and all-cause death, and secondary outcome was an individual event. Results: The propensity score matched cohort included 168,045 statin users and 168,045 non-users (mean age 57 years; median follow-up 5.0 years). Compared to statin non-users, the hazard ratio (HR) was 0.72 (95% confidence interval [CI] 0.70–0.73; P < 0.001) for composite outcomes, 0.80 (0.76–0.84; P < 0.001) for MI, 0.74 (0.71–0.76; P < 0.001) for stroke, and 0.68 (0.66–0.70; P < 0.001) for all-cause death in statin users. The risk reduction was most prominent in subjects aged 40–74 years, attenuated but significant in those aged ≥75 years, and not significant in those aged <40 years. Conclusions: Statin showed a protective effect against CVD and all-cause death in type 2 diabetes; this effect was reduced beyond the age of 75 years and disappeared in young patients aged <40 years.