Physicians' Academy for Cardiovascular Education

Postmenopausal use of statins and risk of diabetes

Literature - Culver AL et al, Arch Intern Med. 2012 Jan 10

Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative.


Culver AL, Ockene IS, Balasubramanian R, Olendzki BC, Sepavich DM, Wactawski-Wende J, Manson JE, Qiao Y, Liu S, Merriam PA, Rahilly-Tierny C, Thomas F, Berger JS, Ockene JK, Curb JD, Ma Y.

Arch Intern Med. 2012 Jan 10.


Background

Due to treatment effectiveness, the use of statins in primary and secondary prevention increases progressively, especially in the elderly [1]. With a widespread use possible risks become more visible, such as an increased incidence of diabetes mellitus. DM associated with the use of statins may be more common in the elderly, women and Asians [2-4].
Insufficient research has been done into postmenopausal women [5]. This study evaluated data of almost 155.000 postmenopausal women without diabetes (age 50-79) who participated in the Women’s Health Initiative between 1993 and 1998.
At recruitment, 7% of the women used statins.

Main results

Risk for DM is higher than suggested in previous studies. In women using statins, risk was increased with 48% (95% CI 1.38-1.59), no matter which statin was used.

Use of statin at baseline?
Patients no.
New onset DM no.
Unadjusted HR
Multivariate-adjusted HR*
Yes
No
10834
143006
1076 (9.93)
9166 (6.41)
1.71 (1.61-1.83)
1 (referentie)
1.48 (1.38-1.59)
1 (referentie)

*HR adjusted for age, race, education, cigarette smoking BMI, physical activity, alcohol intake, energy intake, family history of DM, hormone therapy use, study arms, and self-reported CVD at baseline.

Conclusion

An increased risk of DM in postmenopausal women using statins seems to be a medication class effect. Further research into sort of statin and dosing may clarify the mechanisms behind.

Statins still are very effective drugs for decreasing cardiovascular risk and stroke risk. Patients using statins should be tested for diabetes; clinicians should be aware of possible symptoms.


 

Abstract


BACKGROUND:

This study investigates whether the incidence of new-onset diabetes mellitus (DM) is associated with statin use among postmenopausal women participating in the Women's Health Initiative (WHI).


METHODS:

The WHI recruited 161 808 postmenopausal women aged 50 to 79 years at 40 clinical centers across the United States from 1993 to 1998 with ongoing follow-up. The current analysis includes data through 2005. Statin use was captured at enrollment and year 3. Incident DM status was determined annually from enrollment. Cox proportional hazards models were used to estimate the risk of DM by statin use, with adjustments for propensity score and other potential confounding factors. Subgroup analyses by race/ethnicity, obesity status, and age group were conducted to uncover effect modification.


RESULTS:

This investigation included 153 840 women without DM and no missing data at baseline. At baseline, 7.04% reported taking statin medication. There were 10 242 incident cases of self-reported DM over 1 004 466 person-years of follow-up. Statin use at baseline was associated with an increased risk of DM (hazard ratio [HR], 1.71; 95% CI, 1.61-1.83). This association remained after adjusting for other potential confounders (multivariate-adjusted HR, 1.48; 95% CI, 1.38-1.59) and was observed for all types of statin medications. Subset analyses evaluating the association of self-reported DM with longitudinal measures of statin use in 125 575 women confirmed these findings.


CONCLUSIONS:

Statin medication use in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population.


References

1. Mann D, Reynolds K, Smith D, Muntner P. Trends in statin use and low-density lipoprotein cholesterol levels among US adults: impact of the 2001 National Cholesterol Education Program guidelines. Ann Pharmacother. 2008;42(9):1208-1215.
2. Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375(9716):735-742.
3. Mora S, Glynn RJ, Hsia J, MacFadyen JG, Genest J, Ridker PM. Statins for the primary prevention of cardiovascular events in women with elevated highsensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials. Circulation.2010;121(9):1069-1077.
4. Chan JC, Malik V, Jia W, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129-2140.
5. Mills EJ, Wu P, Chong G, et al. Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170,255 patients from 76 randomized trials. QJM. 2011;104(2):109-124.

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