Statin users consumed more calories and fat over time, while nonusers did not

Sugiyama T, Tsugawa Y, Tseng CH et al.,
JAMA Intern Med. 2014 Apr 24. doi: 10.1001/jamainternmed.2014.1927

Background

Dietary modification is a key component of antihyperlipidemic therapy. Statins have been taken up in the American College of Cardiology/American Heart Association (ACC/AHA) guideline as the most effective of pharmacotherapies for treatment of hyperlipidaemia [1].
Caloric intake in US adults increased from the 1970s through the 1990s [2], reaching a plateau starting in the 1999-2000 period [3]. The proportion of calories from fat consumed by US adults decreased from the 1970s to the 1990s [2], after which a stable trend was seen in 1999-2000 [3].
This study examined the time trend of caloric and fat intake in statins users and nonusers. To this extend, data from the National Health and Nutrition Examination Survey (NHANES) was used, from 1999 through 2010.

Main results

• Over the decade of observation, the proportion of statin users increased from 7.5% to 16.5%. The proportion of the population who did not use statins and did not have hyperlipidaemia decreased from 74.6% to 67.8% over this period, while the proportion of nonusers without hyperlipidaemia did not change significantly.
• In 1999/2000, statin users had both lower caloric intake (2000 vs. 2179 kcal/day, P=0.007) and lower fat intake (71.7 vs. 81.2 g/d, P=0.003) than statin nonusers. Gaps between the two groups became smaller with time. In 2009-2010 statin users had both nonsignificantly higher caloric and fat intake than non users.
• Significantly different time trends were observed for caloric intake and fat intake in statin users and nonusers, in that higher caloric (9.6%) and fat intake (14.4%) was seen at the end of the decade of observation in statin users. No change over time was seen for caloric intake in statin non-users, while fat intake first increased somewhat until 2003-2004, and then gradually declined.
• When statin nonusers were stratified into those with and without hyperlipidaemia, they showed a similar time trend of caloric intake. Diabetes could not explain the differences in time trends between statin users and nonusers either.
• BMI increased faster over the observation period in statin users than in nonusers, although both groups showed a significant increasing trend.

Conclusion

Over a decade in which statin use more than doubled, statin users consumed more calories and fat than earlier cohorts. Nonusers did not increase their calorie and fat intake. Statins users started out with lower calorie and fat intake than nonusers in 1999-2000, but this difference was lost in the next decade. These data suggest that the importance of dietary modification needs continued emphasis.
If these data imply that further expansion of statin use may result in more users not following dietary recommendations, it should be stressed that measures should be taken to reduce the likelihood of statin use being associated with increased caloric and fat intake and weight gain.

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References

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Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults
(Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497.
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through 2007-2008. NCHS Data Brief. 2010;Nov(49):1-8.