Role of diuretics, β blockers, and statins in increasing the risk of diabetes in patients with impaired glucose tolerance: reanalysis of data from the NAVIGATOR study

被引：59

作者：

Shen, Lan ^{[1
,2
]}

Shah, Bimal R. ^{[1
]}

Reyes, Eric M. ^{[1
]}

Thomas, Laine ^{[1
]}

Wojdyla, Daniel ^{[1
]}

Diem, Peter ^{[3
]}

Leiter, Lawrence A. ^{[4
]}

Charbonnel, Bernard ^{[5
]}

Mareev, Viacheslav ^{[6
]}

Horton, Edward S. ^{[7
]}

Haffner, Steven M. ^{[8
]}

Soska, Vladimir ^{[9
,10
]}

Holman, Rury ^{[11
]}

Bethel, M. Angelyn ^{[8
]}

Schaper, Frank ^{[12
]}

Sun, Jie-Lena ^{[1
]}

McMurray, John J. V. ^{[13
]}

Califf, Robert M. ^{[1
]}

Krum, Henry ^{[14
]}

机构：

[1] Duke Clin Res Inst, Durham, NC USA

[2] Shanghai Jiao Tong Univ, Shanghai Renji Hosp, Dept Cardiol, Shanghai 200030, Peoples R China

[3] Univ Bern, Univ Hosp, Dept Endocrinol Diabet & Clin Nutr, CH-3012 Bern, Switzerland

[4] St Michaels Hosp, Toronto, ON M5B 1W8, Canada

[5] Univ Hosp, Dept Endocrinol, Nantes, France

[6] Moscow MV Lomonosov State Univ, Moscow, Russia

[7] Joslin Diabet Ctr, Boston, MA 02215 USA

[8] Univ Oxford, Oxford Ctr Diabet Endocrinol & Metab, Diabet Trials Unit, Oxford, England

[9] Masaryk Univ, Clin Internal Med 2, Brno, Czech Republic

[10] Masaryk Univ, Fac Med, Dept Biochem, Brno, Czech Republic

[11] Churchill Hosp, Oxford OX3 7LJ, England

[12] Tech Univ Dresden, Ctr Clin Studies Metab & Endocrinol Knowledge & T, Dresden, Germany

[13] Univ Glasgow, British Heart Fdn, Cardiovasc Res Ctr, Glasgow G12 8QQ, Lanark, Scotland

[14] Monash Univ, Alfred Hosp, Sch Publ Hlth & Prevent Med, Monash Ctr Cardiovasc Res & Educ Therapeut, Melbourne, Vic 3004, Australia

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2013年 / 347卷

关键词：

CARDIOVASCULAR MORBIDITY; ANTIHYPERTENSIVE DRUGS; PRIMARY PREVENTION; RANDOMIZED-TRIAL; BLOOD-PRESSURE; MELLITUS; THERAPY; HYPERTENSION; MORTALITY; NATEGLINIDE;

D O I：

10.1136/bmj.f6745

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To examine the degree to which use of beta blockers, statins, and diuretics in patients with impaired glucose tolerance and other cardiovascular risk factors is associated with new onset diabetes. Design Reanalysis of data from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. Setting NAVIGATOR trial. Participants Patients who at baseline (enrolment) were treatment naive to beta blockers (n=5640), diuretics (n=6346), statins (n=6146), and calcium channel blockers (n=6294). Use of calcium channel blocker was used as a metabolically neutral control. Main outcome measures Development of new onset diabetes diagnosed by standard plasma glucose level in all participants and confirmed with glucose tolerance testing within 12 weeks after the increased glucose value was recorded. The relation between each treatment and new onset diabetes was evaluated using marginal structural models for causal inference, to account for time dependent confounding in treatment assignment. Results During the median five years of follow-up, beta blockers were started in 915 (16.2%) patients, diuretics in 1316 (20.7%), statins in 1353 (22.0%), and calcium channel blockers in 1171 (18.6%). After adjusting for baseline characteristics and time varying confounders, diuretics and statins were both associated with an increased risk of new onset diabetes (hazard ratio 1.23, 95% confidence interval 1.06 to 1.44, and 1.32, 1.14 to 1.48, respectively), whereas beta blockers and calcium channel blockers were not associated with new onset diabetes (1.10, 0.92 to 1.31, and 0.95, 0.79 to 1.13, respectively). Conclusions Among people with impaired glucose tolerance and other cardiovascular risk factors and with serial glucose measurements, diuretics and statins were associated with an increased risk of new onset diabetes, whereas the effect of beta blockers was non-significant.

引用

页数：11

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