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Statin Use Is Associated With Incident Diabetes Mellitus Among Patients in the HIV Outpatient Study
Kenneth A Lichtenstein1, Rachel L D Hart, Kathleen C Wood
1*Department of Medicine, National Jewish Health, Denver, CO; †Research Department, Cerner Corporation, Kansas City, MO; ‡University of California, San Diego, CA; and §Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
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.