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

Culver, Annie L.

doi:10.1001/archinternmed.2011.625

Cited by 394 publications

(279 citation statements)

References 45 publications

Supporting

Mentioning

255

Contrasting

Unclassified

Order By: Relevance

“…47,224,226,227 Prior to these reports from randomized trials, adverse associations had not been reported between statin therapy and diabetes incidence in observational studies, although several reports of such associations have been published subsequently. 228,229 Recently, it has been found that genetic variants that reduce the activity of HMGCoA reductase (which is analogous to inhibiting this enzyme with a statin) are associated with increased incidence of diabetes. 230 On the other hand, individuals with familial hypercholesterolaemia -in whom the numbers and function of LDL-receptors on cell surfaces are reduced (by contrast with the increase in receptors produced by statins) -had been diagnosed with diabetes less frequently than their unaffected relatives.…”

Section: Increases In Rates Of Diabetes Mellitusmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

View full text Add to dashboard Cite

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms SummaryThis review is intended to help clinicians, patients and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomized controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment.Large-scale randomized trial evidence shows that statin therapy reduces the risk of heart attacks, ischaemic strokes and coronary revascularization procedures ("major vascular events") by about one quarter for each mmol/L reduction in low density lipoprotein (LDL) cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (e.g. atorvastatin 40 mg daily, costing about £2 per

show abstract

Section: Increases In Rates Of Diabetes Mellitusmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…61 In a secondary analysis of the Women's Health Initiative data, statin use was associated with an increased risk of diabetes (adjusted hazard ratio [HR] 1.48; 95 % CI 1.38-1.59). 62 Other observational studies have noted higher adjusted risk of incident diabetes among statin users versus nonusers. ranging from 2.8 to 4.7.…”

Section: Discussionmentioning

confidence: 97%

Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: Statin use is associated with increased incidence of diabetes and possibly with increased body weight and reduced exercise capacity. Data on the longterm effects of these associations in healthy adults, however, are very limited. In addition, the relationship between these effects and diabetic complications has not been adequately studied. OBJECTIVE: To examine the association between statin use and new-onset diabetes, diabetic complications, and overweight/obesity in a cohort of healthy adults. RESEARCH DESIGN: This was a retrospective cohort study. PARTICIPANTS: Subjects were Tricare beneficiaries who were evaluated between October 1, 2003 and March 1, 2012. Patients were divided into statin users and nonusers. INTERVENTION: We excluded patients who, at baseline, had a preexisting disease indicative of cardiovascular diseases, any positive element of the Charlson comorbidity index (including diabetes mellitus), or life-limiting chronic diseases. Using 42 baseline characteristics, we generated a propensity score to match statin users and nonusers. MAIN MEASURES: Outcomes assessed included newonset diabetes, diabetic complications, and overweight/ obesity. KEY RESULTS: A total of 25,970 patients (3982 statin users and 21,988 nonusers) were identified as healthy adults at baseline. Of these, 3351 statins users and 3351 nonusers were propensity score-matched. Statin users had higher odds of new-onset diabetes (odds ratio [OR] 1.87; 95 % confidence interval [95 % CI] 1.67-2.01), diabetes with complications (OR 2.50; 95 % CI 1.88-3.32), and overweight/obesity (OR 1.14; 95 % CI 1.04-1.25). Secondary and sensitivity analyses demonstrated similar findings. CONCLUSIONS: Diabetes, diabetic complications, and overweight/obesity were more commonly diagnosed among statin-users than similar nonusers in a healthy cohort of adults. This study demonstrates that short-term clinical trials might not fully describe the risk/benefit of long-term statin use for primary prevention.

show abstract

“…However, very few studies have compared the diabetogenic effects of statins across different races. Recently, a sub-analysis of observational data from the Women's Health Initiative (WHI) suggested that, compared to statin non-users, statintreated post-menopausal women (N ¼ 3922) from Asia and the Pacific Islands had a non-significant trend towards a higher risk of developing T2D (HR 1.78; 95% CI 1.32e2.40) than their Caucasian (HR 1.49; 1.38e1.62) and African American counterparts (HR 1.18; 0.96e1.45) [106]. These results must be cautiously interpreted given the observational nature of the data.…”

Section: Is the Diabetogenicity Of Statins Consistent Across All Patimentioning

confidence: 99%

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

Sattar¹,

Ginsberg

Ray

et al. 2014

Atherosclerosis Supplements

View full text Add to dashboard Cite

Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines.

show abstract

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

Abstract: 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.

Cited by 394 publications

References 45 publications

Interpretation of the evidence for the efficacy and safety of statin therapy

Interpretation of the evidence for the efficacy and safety of statin therapy

Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

Contact Info

Product

Resources

About