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People on statins at greater risk of skin infections and diabetes

Monitor blood glucose levels of patients predisposed to diabetes, and be mindful of possible raised SSTI risks

Louise Prime

Thursday, 10 October 2019

Doctors should be aware of the link between statins and skin and soft tissue infections (SSTIs) and, where appropriate, monitor blood glucose levels of statin users, researchers have warned after their study*, published in the British Journal of Clinical Pharmacology, showed significant associations between statin use and risks of SSTIs and diabetes.

The study authors pointed out that there has been conflicting evidence regarding statins’ impact on the risk of skin infection – although it has suggested that statins might reduce the risk of Staphylococcus aureus infections, their use has “ironically” been associated with new-onset diabetes mellitus, itself a risk factor for SSTIs.

They analysed Australian Department of Veterans’ Affairs data on prescription claims for 2001-2011, in order to examine the interrelationships between: statins and SSTIs; statins and diabetes; and diabetes and SSTIs; as well as whether statins increased the risk of SSTIs, independent of diabetes status. They found that:

  • Overall, statins were associated with a significant risk of SSTIs and this risk was similar over 91, 182 or 365 days – with the greatest influence from atorvastatin and simvastatin.
  • Statins were also associated with a significant risk of new-onset diabetes, with a slight gradual decrease in risk over 91, 182 and 365 days. Atorvastatin and simvastatin were also the greatest contributors to this outcome (although the individual results of atorvastatin and simvastatin were not statistically significant over 365 days).
  • Patients with diabetes were associated with increased risk of SSTIs at the 182 and 365-days window, but the risk was nonsignificant at the 91-days window.
  • The increased SSTI risk appears to be unbiased by either diabetes or socio-economic statuses – both non-diabetic and diabetic statin users were found to have significant SSTI risks over 91, 182, and 365 days.

The researchers commented: “Our study supports the hypothesis that statin users are at increased risk of SSTIs and this risk was likely independent of diabetes status or the healthy user effect. Statins may increase SSTI risk via direct or indirect mechanisms… Further clinical studies are required to confirm these mechanisms, as well as to ascertain the effect of statins on gut dysbiosis, impaired bile acid metabolism, vitamin D levels, and cholesterol inhibition on skin function.”

They concluded: “Regardless of the actual mechanism(s), it would seem prudent for clinicians to monitor blood glucose levels of statin users who are predisposed to diabetes, and be mindful of possible increased SSTI risks in such patients.”

*Ko HHT, Lareu RR, Dix BR, et al. A sequence symmetry analysis of the interrelationships between statins, diabetes, and skin infections. British Journal of Clinical Pharmacology, First published: 8 October 2019. DOI:10.1111/bcp.14077

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