Statin Users Have Increased Risk Of Diabetes and Obesity

Ishak Mansi, MD Staff Internist, VA North Texas Health System.   Professor in Department of Medicine & Department of Clinical Sciences, Division of Outcomes and Health services Research, University of Texas Southwestern, Dallas, TXMedicalResearch.com Interview with:
Ishak Mansi, MD
Staff Internist, VA North Texas Health System.
Professor in Department of Medicine &
Department of Clinical Sciences, Division of Outcomes and Health services Research, University of Texas Southwestern, Dallas, TX

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Mansi:  Statin use is associated with increased incidence of diabetes, and possibly increased body weight, and less exercise capacity. Data on the long-term effects of these associations in healthy adults are very limited. Additionally, the effects of these associations on diabetic complications have not been adequately studied.

Dr. Mansi at VA North Texas Health System, Dallas and Professor of Medicine and Clinical Sciences at the University of Texas Southwestern, Dallas, TX and his colleagues found that among generally healthy individuals, statin-users in comparison to non-users had a higher odds of being diagnosed with new onset diabetes, diabetes with complications, and overweight/obesity.

The researchers examined the records of tens of thousands of Tricare beneficiaries, during the period from 10/1/2003 to 3/1/2012. After excluding patients who had at baseline a preexisting cardiovascular diseases or severe chronic diseases that may be life-limiting (including diabetes mellitus), they identified a cohort of 25,970 patients as “healthy cohort”. They, further, matched 3,351 statins-users and 3,351 nonusers on several baseline characteristics to ensure comparability.

There are 3 main important findings for our study:

  1. Statin use was associated with significantly higher risk of new onset diabetes even in a very healthy population. Whereas the risk of diabetes with statins is known, it was thought that this may be due to the overall multiple risks of statin-users (that caused them to receive statins as a therapy).
  2. Statin use was associated with very high risk of diabetes complications in this healthy population: this was never shown before.
  3. Statin use is associated with higher risk of obesity: this also is widely unknown. However, few studies have noted this (one study using patient survey noted this, another study using Mendelian randomization showed it, and post-hoc analysis of a clinical trial showed that statin user gained more weight). Our study, which used a different methodology (retrospective cohort study) add another piece of evidence. Obesity is at endemic level in the US and treatment options are limited.

High-intensity statins was associated with greater risks of all outcomes.

This article is published in the Journal of General Internal Medicine (JGIM). JGIM is the official journal of the Society of General Internal Medicine.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Mansi: For clinicians: our study cannot be used to make conclusion about the overall benefit of statins for primary prevention and that further study in this area is needed to confirm our findings. Rather, this study should alert researchers, guideline writers, and policy makers that short-term clinical trials might not fully describe the risk/benefit of long-term statin use for primary prevention (primary prevention means preventing disease from occurring in patients in whom the disease was never diagnosed before). Additionally, statin effects on overall comorbidity, not only cardiovascular morbidity, need to become part of the risk/benefit assessment. Policy makers need to make funding for such research a priority.

Additionally, the importance of knowing statin-associated adverse events is to inform patients about risk and benefits of therapy, specifically in primary prevention. In primary prevention, contrary to secondary prevention, we are addressing the lives of billions of patients who are supposedly healthy; yet, we intervene in their lives and ask them to endure costs, discomfort, medical tests in hope of having a better future. So, it has a massive ethical commitment and economic impact.

For patients: No patient should stop taking their statins based on our study, since statin therapy is a cornerstone in treatment of cardiovascular diseases and have been clearly shown to lower mortality and disease progression. Knowing these risks may motivate a patient to quit smoking to lower risk rather than swallowing a tablet, or may motivate patient to lose weight and exercise.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Mansi: I believe that our study primarily shows the need for longer-term statin clinical trials. It also shows that research funding agencies need to make funds available for more studies of this type. Our study shows that there are gaps in statins primary prevention clinical trials. Additionally, statin effects on overall comorbidity, not only cardiovascular morbidity, need to become part of the risk/benefit assessment. Policy makers need to make funding for such research a priority. We need other studies, similar to ours, to confirm our findings. For these studies to be performed, specific funding mechanisms for such studies are urgently needed (most statin studies were funded by drug companies, and it is unlikely that they will fund such studies).

Citation:

Ishak Mansi, Christopher R. Frei, Chen-Pin Wang, Eric M. Mortensen. Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults. Journal of General Internal Medicine, 2015; DOI: 10.1007/s11606-015-3335-1

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MedicalResearch.com Interview with:, & Ishak Mansi, MD (2015). Statin Users Have Increased Risk Of Diabetes