October 29, 2019
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Statin use raises risks for new-onset diabetes, skin infections

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The use of statins for as little as 91 days is associated with an increased risk for skin infections via diabetogenic and nondiabetogenic mechanisms, according to findings published in the British Journal of Pharmacology.

“The widespread use of statins will likely continue with guidelines across the world recommending statin use for prevention of cardiovascular diseases,” Humphrey H. T. Ko, BSc, a doctoral student at the School of Pharmacy and Biomedical Sciences at Curtin University in Perth, Western Australia, told Endocrine Today. “Hence, there is a need for clinicians to be mindful that statin use may be associated with diabetes, as well as a possible increased risk for skin infections. Statin users who are predisposed to diabetes would thus likely benefit from blood glucose monitoring.”

Ko and colleagues performed a sequence symmetry analysis using prescription claims (2001-2011) from the Australian Department of Veterans Affairs to determine the interrelationships between statin use and skin and soft tissue infections, statin use and diabetes, and diabetes and skin and soft tissue infections; as well as whether statins increased the risk for skin and soft tissue infections independent of diabetes status. Researchers calculated adjusted sequence ratios at 91, 182 and 365 days of statin use.

Overall, statins were associated with increased risk for skin and soft tissue infections, with similar risks observed at 91 days (adjusted sequence ratio = 1.4; 95% CI, 1.29-1.52), 182 days (adjusted sequence ratio = 1.41; 95% CI, 1.33-1.5) or 365 days (adjusted sequence ratio = 1.4; 95% CI, 1.34-1.47) of statin use. Researchers observed the strongest association between skin and soft tissue infections and use of atorvastatin and simvastatin.

Statins were also associated with greater risk for new-onset diabetes, with a slight decrease in risk gradually at 91 days (adjusted sequence ratio = 1.19; 95% CI, 1.11-1.26), 182 days (adjusted sequence ratio = 1.14; 95% CI, 1.08-1.21) and 365 days (adjusted sequence ratio = 1.09; 95% CI, 1.04-1.15).

“Atorvastatin and simvastatin were also the greatest contributors to this outcome, albeit the individual results of atorvastatin and simvastatin were not statistically significant over 365 days,” the researchers wrote.

Individuals with diabetes were associated with increased risk for skin and soft tissue infections at the 182- and 365-day windows, with adjusted sequences ratios of 1.2 (95% CI, 1.09-1.32) and 1.24 (95% CI, 1.15-1.33), respectively; however, the risk was nonsignificant at the 91-day window.

“Further clinical studies are required to confirm these mechanisms, as well as to ascertain the effect of statins on gut dysbiosis, impaired bile acid metabolism, vitamin D levels and cholesterol inhibition on skin function,” the researchers wrote. “Regardless of the actual mechanisms, it would seem prudent for clinicians to monitor blood glucose levels of statin users who are predisposed to diabetes and be mindful of possible increased skin and soft tissue infection risks in such patients.” – by Regina Schaffer

For more information:

Humphrey H. T. Ko, BSc, can be reached at the School of Pharmacy and Biomedical Sciences, Curtin University, 306, Bentley WA 6102, Australia; email: h.ko2@postgrad.curtin.edu.au.

Disclosures: The authors report no relevant financial disclosures.