Tuesday, February 21, 2012

With >50% Increased Risk to Develop New-Onset Diabetes, Statins are "Starter Drugs" for Post-Menopausal Women. Plus: Younger, Leaner & Asian Women at Greatest Risk

Image 1: A statin here, some metformin to keep the collateral at bay, add an ACE inhibitor and some anti-coagulant drugs and you have a delicious cocktail of highly profitable pharmaceuticals...
Do you remember how creatine has gotten a bad rep within the mass media, a few years ago? Initially touted as an over-the-counter "steroid" by a clueless journalist, the did not, as you would have expected backpedal, or at least forget about the whole thing, when some experts raised their hands and said: "Wait a minute! Creatine is a naturally occuring amino acid with thousands of studies backing its efficacy...", no, they just turned it around and said: "Look, this is how it goes: First creatine, then androstenedione, next real gear! This stuff is a starter drug which will make our youth go astray!" ... Today, or I should say, on January 9, 2012, a study on another, yet in the eyes of the press obviously way less "starter drug" has been published - the title: "Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women’s Health Initiative"

Keep an eye on your mommy, she might be doing drugs!

As a diligent student of the SuppVersity and thoughtful observer of the blogosphere, I probably won't have to tell you that taking a stating, although they could be life-saving for a infinitesimal percentage of the population, is not as good an idea as the luckily in this part of the world forbidden TV commercials will make. At least for women, the "preventive" use that is so highly advertised by the statin producing pharmaceutical industry, is associated with a 61% increase to develop new-onset diabetes (48% if in addition to age, race and ethnicity, education, cigarette smoking, BMI, physical activity, alcohol intake, energy intake, familiy history of diabetes, and hormone therapy were also considered as confounding factors in the calculation of the hazard ratio), in the 120,173 women without pre-existing cardiovascular disease in the enormous cohort of the Women's Health Initiative study.
Figure 1:  Risk of developing diabetes by statin use among women with and without medical history of cardiovascular disease at baseline; unadjusted, age-and race/ethnicity and multivariate (age, race/ethnicity, education, cigarette smoking, body mass index, physical activity, alcohol intake, energy intake, family history of DM, and hormone therapy use) adjusted hazard ratios (data adapted from Culver. 2011)
When all confounding factors (see brackets above) are considered the "additional" risk decreases (BMI, physical activity and hormone therapy are probably the culprits, here) and the inter-group difference vanishes, so that this leaves us with a ~50% increased risk to develop type II diabetes in a cohort of 153,840 women, whose mean age was 63.17 years - now, if one discarded that the data in column 2 of figure 1 is already age-adjusted you could well argue, that at this age, it is "just normal" to develop some blood sugar issues.
Figure 2: Association between new-onset diabetes risk and statin use at baseline within different age, race/ethnicity, and BMI subgroups of the 153,840 participants; data shown as unadjusted and multivariate (age, race/ethnicity, education, cigarette smoking, body mass index, physical activity, alcohol intake, energy intake, family history of DM, and hormone therapy use - age, race and BMI were obviously excluded in the respective subgroup analysis) adjusted hazard ratios (data adapted from Culver. 2011)
Aside from the fact that this is an absolutely idiotic, yet often uttered statement (I hear that esp. from people who are already "at that age" and unwilling to do something about their (pre-)diabetic state, by the way), the data in figure 2 shows quite clearly that the "younger" ladies are at particular risk to develop diabetes. Even after the aforementioned adjustments for BMI, physical activity and co. were made the hazard ratio (a measure of the increased risk, with 1.0 = normal and e.g. 1.5 = 50% increased risk) of developing new-onset diabetes was slightly higher (+3%). It would thusly be interesting to see the hazard ratios for pre-menopausal women, or even teens and twens, an increasing number of whom is put on a "live-saving" statin - at the latest, when their cholesterol levels surpass the repeatedly lowered "cut-off" limit of currently 240mg/dl (NHLBI. 2012).

If your mama takes statins is a "light-weight" (for her age) and from Asia or the pacific islands, you better get her some Metformin - she probably is going to need it soon...

If you further scrutinize the data in figure 2, it become pretty obvious that the group(s) with the highest risk to develop new-onset diabetes upon being treated with statins are
  • women from Asia or the Pacific Islands, with an increased risk of +112% (unadjusted) and +78% (adjusted for the aforementioned variables except from ethnicity, obviously), and
  • women with a BMI of <25 kg/m², with an increased risk of +240% (unadjusted) and +89% (adjusted for the aforementioned variables except from BMI, obviously)
Whether this would mean that light-weight Asians / Pacific Islanders who are put on statin therapy would be even more likely to develop new-onset diabetes, would admittedly need further elucidation.
Figure 3: Association between new-onest diabetes risk and statin use at baseline in 153,840 participants; data shown as unadjusted, adjusted for age / race /ethnicity and multivariate (details see figure 1) adjusted hazard ratios (data adapted from Culver. 2011)
It is however, at least in my mind, not unlikely - in particular if they are / are going to be on the statin for an extended period of time (cf. figure 3). Against that background it is quite comforting to know that most statin dealers... ah, pardon pharma companies, also have one, many even a whole host of diabetes drugs for doctors to chose from, when - after a few months of treatment - their formerly only "hypercholesterolemic" female patients have developed full-blown diabetes!

So, let's just hope that the sons and grandsons of these women did not resort to creatine or other dangerous "steroids" from their local GNCs by then! I mean, otherwise it would be likely that they were going on a "roid rage" against their mommy's and granny's doctors, when they see the muscles and brains of their insulin-dependent loved ones wither under the influence of their cholesterol lowering medication.