BACKGROUND: The survival benefit of statins in nontrial populations of persons 
with diabetes is unknown.
OBJECTIVE: : We sought to determine all-cause mortality in fiscal year 2001 
(FY01) after statin initiation in FY 99 and/or FY00 in individuals with diabetes 
in the Veterans Healthcare Administration (VHA).
METHODS: Using a retrospective longitudinal cohort analysis, we analyzed 201,102 
veterans with diabetes from 104 VHA facilities with medical, pharmacy, and 
laboratory information from VHA and Medicare databases. Patients with statin 
exposure, defined as having medication possession coverage >50% of eligible days 
in FY99 and/or FY00, were characterized as initiators if no statin prescription 
was found in FY98. Otherwise, they were characterized as continuing users. We 
defined 4 statin exposure groups: FY99 only, FY00 only, both FY99 and 00, and 
neither year. All-cause mortality was determined in FY01. Propensity score 
matched comparisons were used to corroborate results from mixed effects logistic 
models.
RESULTS: FY01 mortality was no different between FY99-only initiators and the 
nonexposure group (odds ratio [OR] = 1.08, P = 0.429). In contrast, FY00-only 
and FY99-00 initiator groups showed odds ratio of 0.75 (P < 0.0001) and 0.71 (P 
< 0.0001), respectively. There was a similar benefit for continuing users. 
Propensity analysis demonstrated consistent findings. Increased statin adherence 
from >50% to >75% was associated with increased benefit (OR = 0.71, P < 0.0001 
versus OR = 0.62, P = 0.0002).
CONCLUSIONS: One to 2-year statin exposure is associated with a 25% to 29% risk 
reduction in all-cause mortality of the subsequent year in a high-risk diabetes 
cohort.