Microsoft word - 0412-1- full article for test statin use and risk of diabetes mellitus

Statin use in postmenopausal women increases risk
of type 2 diabetes, but benefits may still outweigh risks
A recent study has found that that the use of statins in postmenopausal women is associated with an increased risk
of diabetes mel itus (DM). However, further studies are warranted, and some experts say that the benefits stil
outweigh the risks.
The study set out to evaluate whether statin use in postmenopausal women led to the development of new-onset
DM. Participants (n=161,808) were recruited from the Women's Health Initiative (WHI) with constant fol ow-up after
the study ended (analysis through 2005). The overal statin effect on causing DM by specific agents was evaluated
annual y from study entry.
Statins were categorized by potency in lowering low-density lipoprotein cholesterol. They were categorized as low
(fluvastatin, lovastatin, pravastatin) or high (simvastatin, atorvastatin). Women where stratified by body mass index
(BMI), age group, and race/ethnicity. At enrol ment and Year 3, statin use was identified. A total of 10,242 incident
cases of self-reported DM occurred in over 1,004,466 person-years of follow-up.
Statin use was unfailingly connected to increased DM risk by age, ethnicity, and BMI, was associated with different
statin medications, and included women with or without known cardiovascular disease. A subset analysis that
evaluated the association of self-reported DM with longitudinal measures of statin use in 125,575 women confirmed
the findings of increased DM risk.
Statin use at baseline was associated with an increased risk of DM, which remained after adjustment for
confounders. The authors noted that their findings are consistent with other studies, in that new-onset DM is a "class
effect" and not related to either the individual agent or potency.
A. Ramachandran, MD, PhD, DSc, FRCP (Lond.), MNAMS, FICP,FRCP (Edin), chairman/managing director of A.
Ramachandran’s Diabetes Hospitals and president of India Diabetes Research Foundation, Chennai, India, said in
an interview with mdCurrent-India that: “The absolute risk of diabetes is low in this study, and therefore we should
consider whether the benefits of statin therapy outweigh this risk.” He added that in people with diagnosed diabetes
mel itus, statin therapy is always beneficial.
Some study limitations existed: the observational nature of the study whereby there was limited control of
confounders; limited data available on hemoglobin A1c-, lipid- or C-reactive protein values; diabetes type may have
been underreported; and medication adherence not evaluated. There were other potential biases such as an unequal
representation of different statins; unknown "indications for use"; changing statin drugs/doses; potential native
hormonal effects; differences in weight distribution; and weight loss/gain. There also were overlapping confidence
intervals for ethnic differences which need to be cautiously interpreted.
The authors concluded that use of statins in postmenopausal women is associated with an increased risk for DM, but
further study in this population is warranted.
Take-away message: The use of statins in postmenopausal women is associated with an increased risk for diabetes
mel itus, but further study is needed. The benefits may stil outweigh the risks. In people who already have diabetes,
statin therapy is always beneficial.
Source: Culver AL, Ockene IS, Balasubramanian R, et al. Statin Use and Risk of Diabetes Mel itus in
Postmenopausal Women in the Women's Health Initiative. Arch Intern Med. Published online January 9, 2012. doi:
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