Statin Use Is Associated With Incident Diabetes Mellitus Among Patients in the HIV Outpatient Study

Kenneth A. Lichtenstein, MD; Rachel L. D. Hart, MS; Kathleen C. Wood, RN; Samuel Bozzette, MD; Kate Buchacz, PhD; John T. Brooks, MD

Disclosures

J Acquir Immune Defic Syndr. 2015;69(3):306-311. 

In This Article

Abstract and Introduction

Abstract

Introduction: Statin therapy is effective in the prevention of cardiovascular disease in the general population but has been shown to modestly increase the risk for incident diabetes mellitus (DM).

Methods: We analyzed incident DM in HIV Outpatient Study (HOPS) participants followed at 8 HIV clinic sites during 2002–2011, comparing rates among those who initiated statin therapy during that period with those who did not. Using Cox proportional hazards models, we examined the association between cumulative years of statin exposure and the risk of developing DM, after controlling for age, sex, race/ethnicity, antiretroviral history, prevalent hepatitis C, body mass index, and cumulative exposure to protease inhibitor therapy. We also adjusted for propensity scores to account for residual confounding by indication.

Results: Of 4692 patients analyzed, 590 (12.6%) initiated statin therapy and 355 (7.2%) developed DM. Incident DM was independently associated with statin therapy (adjusted hazard ratio, 1.14 per year of statin use), as well as older age, Hispanic/Latino ethnicity, non-Hispanic/Latino black race, antiretroviral-naive status, prevalent hepatitis C, and body mass index ≥30 kg/m2 (P < 0.05 for all). The association of statin use with incident DM was similar in the model adjusted for propensity score.

Conclusions: Statin use was associated with a modestly increased risk of incident DM in an HIV-infected population, similar to existing data for the general population. HIV-infected patients should be monitored for glucose intolerance, but statins should not be withheld if clinically indicated for cardiovascular disease risk reduction.

Introduction

The benefit of statin therapy in primary and secondary prevention of myocardial infarctions has been established in multiple large studies.[1–4] More recently, the association of statin use with increased risk for development of diabetes mellitus (DM) has been noted.[5–8] The JUPITER study found a 25% increase in incident DM with the use of rosuvastatin.[9] In a meta-analysis of 13 statin trials consisting of 91,120 subjects, Sattar et al[10] found a 9% increased risk of incident DM in patients receiving statin therapy. In addition, the association of statins with incident DM has been found to be more prominent in certain populations such as the elderly, women, and Asians.[11,12]

Cardiovascular disease (CVD) in HIV-infected population occurs more frequently when compared with HIV-uninfected controls.[13] Not only are the cohorts of HIV-infected individuals in the United States enriched in persons with traditional cardiovascular risk factors such as tobacco use and obesity but also they are steadily aging, which increases their risk of developing CVD.[14] In addition to these traditional CVD risk factors, the dyslipidemic effects of some antiretroviral agents and the chronic inflammation resulting from HIV infection may also contribute to CVD risk.[15–17] As such, increasing numbers of HIV-infected patients are being prescribed statins. We studied patients enrolled in the HIV Outpatient Study (HOPS) to determine whether the use of statin therapy was associated with an increased incidence of DM.

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