PURLs
A new adjunctive Tx option for venous stasis ulcers
Adding simvastatin to standard wound care improves ulcer healing rates and times as well as the patient’s quality of life.
Similar results were found in a subsequent population-based cohort study of 471,250 nondiabetic patients older than 66 years who were newly prescribed a statin.3 The study authors used the incidence of new diabetes in patients taking pravastatin as the baseline, since it had been associated with reduced rates of diabetes in a large cardiovascular prevention trial.4 Without adjusting for dose, patients were at significantly higher risk of diabetes if prescribed atorvastatin (hazard ratio [HR]=1.22; 95% CI, 1.15-1.29), rosuvastatin (HR=1.18; 95% CI, 1.10-1.26), or simvastatin (HR=1.10; 95% CI, 1.04-1.17) compared with pravastatin. The risk with fluvastatin and lovastatin was similar to pravastatin.
A subanalysis that compared moderate- and high-dose statin therapy with low-dose therapy (atorvastatin <20 mg, rosuvastatin <10 mg, simvastatin <80 mg, or any dose of fluvastatin, lovastatin, or pravastatin) found a 22% increased risk of diabetes (HR=1.22; 95% CI, 1.19-1.26) for moderate-dose therapy (atorvastatin 20-79 mg, rosuvastatin 10-39 mg, or simvastatin >80 mg) and a 30% increased risk (HR=1.3; 95% CI, 1.2-1.4) for high-dose therapy (atorvastatin ≥80 mg or rosuvastatin ≥40 mg).
A cohort trial also shows increased diabetes risk
A smaller subsequent cohort trial based on data from Taiwan National Health Insurance records compared 8412 nondiabetic adult patients (mean age 63 years) taking statins with 33,648 age- and risk-matched controls not taking statins over a mean duration of 7.2 years.5 Statin use was associated with a 15% higher risk of developing diabetes (HR=1.15; 95% CI, 1.08-1.22).
RECOMMENDATIONS
The 2013 American College of Cardiology/American Heart Association guidelines for lipid-lowering therapy recommend that patients taking statins be screened for diabetes according to current screening recommendations.6 The guidelines advise encouraging patients who develop diabetes while on statin therapy to adhere to a heart-healthy dietary pattern, engage in physical activity, achieve and maintain a healthy body weight, cease tobacco use, and continue statin therapy to reduce the risk of cardiovascular events.
