Lichtenstein Kenneth A, Hart Rachel L D, Wood Kathleen C, Bozzette Samuel, Buchacz Kate, Brooks John T
*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.
J Acquir Immune Defic Syndr. 2015 Jul 1;69(3):306-11. doi: 10.1097/QAI.0000000000000581.
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).
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.
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.
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.
他汀类药物治疗对普通人群预防心血管疾病有效，但已显示会适度增加患糖尿病（DM）的风险。
我们分析了2002年至2011年期间在8个艾滋病门诊研究（HOPS）站点接受随访的参与者中糖尿病的发病情况，比较了在此期间开始他汀类药物治疗的患者与未开始治疗的患者的发病率。使用Cox比例风险模型，在控制年龄、性别、种族/民族、抗逆转录病毒治疗史、丙型肝炎感染情况、体重指数以及蛋白酶抑制剂治疗的累积暴露量后，我们研究了他汀类药物暴露的累积年限与患糖尿病风险之间的关联。我们还调整了倾向得分，以考虑因适应证导致的残余混杂因素。
在分析的4692例患者中，590例（12.6%）开始了他汀类药物治疗，355例（7.2%）患糖尿病。糖尿病发病与他汀类药物治疗独立相关（他汀类药物使用每年的调整风险比为1.14），同时还与年龄较大、西班牙裔/拉丁裔种族、非西班牙裔/拉丁裔黑人种族、未接受过抗逆转录病毒治疗、丙型肝炎感染情况以及体重指数≥30kg/m²相关（所有P<0.05）。在调整倾向得分的模型中，他汀类药物使用与糖尿病发病的关联相似。
在感染艾滋病病毒的人群中，使用他汀类药物与患糖尿病的风险适度增加相关，这与普通人群的现有数据相似。应监测感染艾滋病病毒患者的葡萄糖不耐受情况，但如果临床上有降低心血管疾病风险的指征，不应停用他汀类药物。
