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Rischio di diabete per donne in menopausa in terapia con statine

Ancora una conferma sul rischio di sviluppo di diabete di tipo 2 in pazienti in terapia con statine. Questa volta la segnalazione viene da un poderoso studio che fa parte del ben noto Women's Health Initiative (WHI) ed è stato condotto su un totale di 153.840 donne in menopausa di cui il 7% (10.834 donne) assumeva una statina. Il rischio di sviluppare diabete è risultato significativamente più alto in coloro che assumevano una statina ( simvastatina, lovastatina, pravastatina, fluvastatina o atorvastatina), indipendentemente dal tipo di statina e dalla razza/etnia delle donne studiate. Ed è proprio in questi due ultimi punti che sta la forza dello studio che dimostrerebbe che l'emergenza di diabete di tipo 2 sarebbe proprio un effetto comune alla classe farmacologica e indipendente da altri fattori.

Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative

Culver AL, Ockene IS, Balasubramanian R, Olendzki BC, Sepavich DM, Wactawski-Wende J, Manson JE, Qiao Y, Liu S, Merriam PA, Rahilly-Tierny C, Thomas F, Berger JS, Ockene JK, Curb JD, Ma Y

Arch Intern Med 2012;172:144-152

BACKGROUND: This study investigates whether the incidence of new-onset diabetes mellitus (DM) is associated with statin use among postmenopausal women participating in the Women's Health Initiative (WHI).
METHODS: The WHI recruited 161,808 postmenopausal women aged 50 to 79 years at 40 clinical centers across the United States from 1993 to 1998 with ongoing follow-up. The current analysis includes data through 2005. Statin use was captured at enrollment and year 3. Incident DM status was determined annually from enrollment. Cox proportional hazards models were used to estimate the risk of DM by statin use, with adjustments for propensity score and other potential confounding factors. Subgroup analyses by race/ethnicity, obesity status, and age group were conducted to uncover effect modification.
RESULTS: This investigation included 153,840 women without DM and no missing data at baseline. At baseline, 7.04% reported taking statin medication. There were 10,242 incident cases of self-reported DM over 1,004,466 person-years of follow-up. Statin use at baseline was associated with an increased risk of DM (hazard ratio [HR], 1.71; 95% CI, 1.61-1.83). This association remained after adjusting for other potential confounders (multivariate-adjusted HR, 1.48; 95% CI, 1.38-1.59) and was observed for all types of statin medications. Subset analyses evaluating the association of self-reported DM with longitudinal measures of statin use in 125,575 women confirmed these findings.
CONCLUSIONS: Statin medication use in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population.

Arch Intern Med 2012;172:144-152