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To the Editor: The review article “Statins and diabetes: fact, fiction, and clinical implications” 1 left out one major fact: there are sex-based differences in the statin research results, particularly a higher risk for diabetes in postmenopausal women on statins, with an adjusted hazard ratio of 1.48.2 The article promulgated the fiction that statins should be used for primary prevention in women. The first study the author reviewed when discussing the risk of diabetes in “patients” was WOSCOPS—which was an all male study.3
While statin therapy is an effective intervention for secondary prevention of cardiovascular disease in both sexes, it is important to note there is no benefit in rates of all-cause mortality or stroke in women.4 The use of statins for primary prevention in women rightly remains controversial.
Any review article on statins or any condition or drug used in both sexes should include some discussion about sex-based differences. While it might be advanced that the increased risk for diabetes, depression, cognitive impairment, and musculoskeletal pain can be justified in secondary prevention in both sexes, that argument is much, much weaker for primary prevention in women, especially since we have evidence showing a reduction in all-cause mortality and primary cardiovascular reduction in women given early postmenopausal hormone therapy.5
- Rocco M. Statins and diabetes risk: fact, fiction, and clinical implications. Cleve Clin J Med 2012; 79:883–893.
- Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative. Arch Intern Med 2012; 172:144–152.
- Freeman DJ, Norrie J, Sattar N, et al. Pravastatin and the development of diabetes mellitus: evience for a protective treatment effect in WOSCOPS. Circulation 2001; 103:357–362.
- Gutierrez J, Ramirez G, Rundek T, et al. Statin therapy in the prevention of recurrent cardiovascular events. A sex-based meta-analysis. Arch Intern Med 2012; 172:909–919.
- Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomized trial. BMJ 2012; 345:e6409.
To the Editor: The review article “Statins and diabetes: fact, fiction, and clinical implications” 1 left out one major fact: there are sex-based differences in the statin research results, particularly a higher risk for diabetes in postmenopausal women on statins, with an adjusted hazard ratio of 1.48.2 The article promulgated the fiction that statins should be used for primary prevention in women. The first study the author reviewed when discussing the risk of diabetes in “patients” was WOSCOPS—which was an all male study.3
While statin therapy is an effective intervention for secondary prevention of cardiovascular disease in both sexes, it is important to note there is no benefit in rates of all-cause mortality or stroke in women.4 The use of statins for primary prevention in women rightly remains controversial.
Any review article on statins or any condition or drug used in both sexes should include some discussion about sex-based differences. While it might be advanced that the increased risk for diabetes, depression, cognitive impairment, and musculoskeletal pain can be justified in secondary prevention in both sexes, that argument is much, much weaker for primary prevention in women, especially since we have evidence showing a reduction in all-cause mortality and primary cardiovascular reduction in women given early postmenopausal hormone therapy.5
To the Editor: The review article “Statins and diabetes: fact, fiction, and clinical implications” 1 left out one major fact: there are sex-based differences in the statin research results, particularly a higher risk for diabetes in postmenopausal women on statins, with an adjusted hazard ratio of 1.48.2 The article promulgated the fiction that statins should be used for primary prevention in women. The first study the author reviewed when discussing the risk of diabetes in “patients” was WOSCOPS—which was an all male study.3
While statin therapy is an effective intervention for secondary prevention of cardiovascular disease in both sexes, it is important to note there is no benefit in rates of all-cause mortality or stroke in women.4 The use of statins for primary prevention in women rightly remains controversial.
Any review article on statins or any condition or drug used in both sexes should include some discussion about sex-based differences. While it might be advanced that the increased risk for diabetes, depression, cognitive impairment, and musculoskeletal pain can be justified in secondary prevention in both sexes, that argument is much, much weaker for primary prevention in women, especially since we have evidence showing a reduction in all-cause mortality and primary cardiovascular reduction in women given early postmenopausal hormone therapy.5
- Rocco M. Statins and diabetes risk: fact, fiction, and clinical implications. Cleve Clin J Med 2012; 79:883–893.
- Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative. Arch Intern Med 2012; 172:144–152.
- Freeman DJ, Norrie J, Sattar N, et al. Pravastatin and the development of diabetes mellitus: evience for a protective treatment effect in WOSCOPS. Circulation 2001; 103:357–362.
- Gutierrez J, Ramirez G, Rundek T, et al. Statin therapy in the prevention of recurrent cardiovascular events. A sex-based meta-analysis. Arch Intern Med 2012; 172:909–919.
- Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomized trial. BMJ 2012; 345:e6409.
- Rocco M. Statins and diabetes risk: fact, fiction, and clinical implications. Cleve Clin J Med 2012; 79:883–893.
- Culver AL, Ockene IS, Balasubramanian R, et al. Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative. Arch Intern Med 2012; 172:144–152.
- Freeman DJ, Norrie J, Sattar N, et al. Pravastatin and the development of diabetes mellitus: evience for a protective treatment effect in WOSCOPS. Circulation 2001; 103:357–362.
- Gutierrez J, Ramirez G, Rundek T, et al. Statin therapy in the prevention of recurrent cardiovascular events. A sex-based meta-analysis. Arch Intern Med 2012; 172:909–919.
- Schierbeck LL, Rejnmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomized trial. BMJ 2012; 345:e6409.