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Every Year of Statin Therapy Boosts Diabetes Risk 10% in US HIV Cohort
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20th Conference on Retroviruses and Opportunistic Infections, March 3-6, 2013, Atlanta
Diabetes-Statin Link Hinges on Risk
Factors.....http://www.natap.org/2012/HIV/121012_01.htm.....J Am Coll Cardiol. Dec 2012
High-dose statin therapy increases the risk of diabetes:
Meta-analysis .......http://www.natap.org/2011/newsUpdates/062211_02.htm
FDA: New Warning Labels for Statins - Comments on FDA Warning. FDA said patients should not be scared off statins. "The value of statins in preventing heart disease has been clearly
established"........http://www.natap.org/2012/newsUpdates/022912_03.htm
Mark Mascolini
Every year of treatment with lipid-lowering statins boosted the risk of diabetes 10% in members of the HIV Outpatient Study (HOPS) [1]. The results confirm an earlier finding of self-reported diabetes associated with statin use in a large general-population study of US postmenopausal women [2], but the impact of statins seemed more modest in the HOPS analysis.
The HOPS investigators cautioned that "statins should not be avoided if clinically indicated" because of "demonstrated benefits for cardiovascular disease prevention."
In 2012 an analysis of 153,840 postmenopausal women in the Women's Health Initiative, a general-population cohort, determined that statin use at the beginning of follow-up raised the risk of a self-reported new diabetes diagnosis 48% after adjustment for other risk factors [2]. The association held true for all statins considered.
Because abnormal lipids and high glucose are frequent in people with HIV, HOPS investigators conducted this analysis of incident (newly diagnosed) diabetes in members of this six-city, nine-clinic cohort. Observation time began at a person's first HOPS visit from 2002 through 2011 (the index date) and continued until diabetes diagnosis, loss to follow-up, death, or December 31, 2011.
Everyone was at least 18 years old, and no one had used statins or had a diabetes diagnosis before their index visit. The HOPS team defined diabetes as (1) a physician diagnosis, (2) a fasting blood glucose above 125 mg/dL (or 7 mmol/L), or (3) a 30-day or longer prescription of antidiabetic medication.
HOPS investigators recorded statin use and incident diabetes, then used Cox proportional hazards models to assess the association between cumulative statin exposure and incident diabetes. The models adjusted for age, sex, race/ethnicity, antiretroviral exposure, protease inhibitor use, and body mass index. Statin and protease inhibitor use were modeled as time-dependent factors.
The study involved 4962 people tracked for a median of 4.6 years (interquartile range [IQR] 1.8 to 9.0). During that time, physicians prescribed statins for 590 people, and statin therapy lasted for a median of 2.4 years (IQR 1.1 to 4.9).
Compared with people who never took a statin, at the index date statins users were more likely to be older (median 44 versus 40, P < 0.001), non-Hispanic white (58.8% versus 48.9%, P < 0.001), antiretroviral experienced (74.9% versus 65.5%, P < 0.001), and diagnosed with AIDS (48.6% versus 43.4%, P = 0.016). Statin users had greater body mass index (P = 0.003), higher CD4 counts (median 430 versus 394, P < 0.001), and lower viral loads (median 2.4 versus 3.3 log, P < 0.001) at the index date than did nonusers.
In multivariate analysis, every year of statin use raised the diabetes risk 10%. Older age, Hispanic ethnicity, black race, and obesity also independently boosted the risk of a new diabetes diagnosis, at the following adjusted hazard ratios (aHR) (and 95% confidence intervals):
-- Every year of statin use: aHR 1.1 (1.0 to 1.3), P = 0.038
-- Every 10 years of age: aHR 1.6 (1.5 to 1.8), P < 0.001
-- Hispanic (vs white): aHR 2.1 (1.5 to 2.8), P < 0.001
-- Black (vs white); aHR 1.5 (1.1 to 1.9), P < 0.001
-- Body mass index >30 kg/m(2): aHR 3.1 (2.4 to 4.0), P < 0.001
Protease inhibitor use upped the diabetes risk 70%, but this association lacked statistical significance (aHR 1.70, 95% CI 0.9 to 3.2, P = 0.10).
The HOPS team concluded that "exposure to statin therapy appeared to modestly increase the risk of diabetes in our large, diverse HIV-infected adult patient population." But they noted that the impact of statins was smaller in this HIV cohort of relatively young adults than in postmenopausal women in the general US population [2]. They advised that "all HIV-infected patients, including those prescribed statin therapy, should be monitored for glucose intolerance."
References
1. Lichtenstein K, Debes R, Wood K, et al. Statin use is associated with incident diabetes mellitus among patients in the HIV Outpatient Study. 20th Conference on Retroviruses and Opportunistic Infections. March 3-6, 2013. Atlanta. Abstract 767. http://www.retroconference.org/2013b/PDFs/767.pdf.
2. Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Arch Intern Med. 2012;172:144-152. http://archinte.jamanetwork.com/article.aspx?articleid=1108676
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