Statin Therapy and Risk for Diabetes: Deconstructing a Flawed Study

Michael Mogadam, MD

Disclosures

February 24, 2012

In This Article

Introduction

In a recent observational study by Culver and colleagues that was part of the Women's Health Initiative (WHI), statin use was reported to be associated with increased risk for hyperglycemia/"diabetes" among 153,840 postmenopausal women aged 50-79.[1] As expected, this report generated a frenzy of sensational misinterpretation of the data by news media and considerable concern and doubt about the safety of statins among healthcare providers and the public alike. A closer look at this report reveals numerous flaws in the design and data acquisition that render the conclusions highly questionable.

At the start of the study, 7% of the 153,840 women included in the observational study were on various doses of different statins. During follow-up, 10,242 (about 7%) of all women in the study developed hyperglycemia/"diabetes" (1076 had been on statins, 9166 had not). In an unadjusted risk model, statin use at baseline was associated with a 71% increased risk (95% confidence interval [CI]: 1.61-1.83), but after adjusting for some of the more obvious potential confounding variables the risk declined to 48%. The association was observed for all statins, with all doses or duration of statin therapy, and across a range of body mass indices (BMIs <25.0, 25.0-29.9, and >30.0 kg/m2). Interestingly, women with the lowest BMI (<25.0 kg/m2) appeared to be at higher risk for diabetes compared with obese women, a finding that the investigators speculated was related to phenotype or hormonal differences between the women. Quite surprisingly, among African American women, who are more prone to develop diabetes, there was no significant increase in the risk for diabetes associated with statin use at baseline.

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