Receiving treatment with statins is associated with a decreased risk for postpancreatitis diabetes mellitus (PPDM), with a greater risk reduction occurring in regular statin users, according to a study in Clinical Gastroenterology and Hepatology.
Researchers sourced data from Optum Clinformatics’ database to compare PPDM rates among patients who had used statins before their first episode of acute pancreatitis vs patients who had never used statins.
Patients with acute pancreatitis who were diagnosed from January 1, 2008, to January 1, 2021, were identified with diagnosis codes from the International Classification of Diseases (ICD)-Ninth Revision and the ICD-Tenth Revision. Regular statin users were defined as patients who had statin prescriptions filled for at least 80% of the 1 year before their acute pancreatitis diagnosis.
The primary outcome was PPDM. Researchers followed up with patients until June 31, 2021, patients developed diabetes, or patient death.
The cohort included 82,159 patients (median age, 58 [range, 42-73] years; men, 47.1%) who did not use statins or any cholesterol-lowering medication before their diagnosis of acute pancreatitis (statin nonusers) and 9048 patients (median age, 74 [range, 66-81] years; men, 49.7%) who used statins regularly (regular statin users). In addition, 27,272 patients used statins for less than 80% of the 1 year before their acute pancreatitis diagnosis (irregular statin users). The median follow-up was 3.5 (range, 0.5-12.8) years.
In total, 12,590 (10.10%) patients developed PPDM. The 5-year cumulative PPDM incidence was 7.5% (95% CI, 6.9%-8.0%) in regular statin users and 12.65% (95% CI, 12.4%-12.9%) in statin nonusers (difference, -5.2%; 95% CI, -7.4 to -4.3; P <.001).
Regular statin users had a 42% lower risk for PPDM vs statin nonusers (hazard ratio [HR], 0.58; 95% CI, 0.52-0.65; P <.001). Irregular statin users had a 15% lower risk for PPDM compared with statin nonusers (HR, 0.85; 95% CI, 0.81-0.89; P <.001).
The defined daily dose (DDD) was estimated as the total defined dose divided by the time in days between the first and last prescription before onset of acute pancreatitis. Statin doses were analyzed in the following categories of DDD per day: 0.00 (reference), 0.01-0.75, 0.76-1.50, and greater than 1.50.
Compared with no statin use, multivariable-adjusted HRs for PPDM were 0.45 (95% CI, 0.36-0.57; P <.001), 0.58 (95% CI, 0.49-0.70; P <.001), and 0.70 (95% CI, 0.56-0.89; P <.001), respectively.
The 5-year cumulative incidence of insulin-dependent PPDM was 2.4% (95% CI, 1.3%-3.0%) for regular statin users and 6.6% (95% CI, 6.2%-6.9%) among statin nonusers. Regular statin users had a 52% decreased risk for insulin-dependent diabetes vs statin nonusers (HR, 0.48; 95% CI, 0.41-0.56; P <.001).
Limitations include lack of information regarding radiologic findings, inpatient treatments and specific severity grade of pancreatitis, diabetes screening, and patient-level data on statin adherence.
“Among patients with [acute pancreatitis], we observed an association between statin use at the time of presentation and a reduced risk of PPDM, with a reduction of up to 42%,” the study authors wrote. “Our findings support the need for randomized clinical trials with longitudinal follow-up designed to study the role of statins in preventing PPDM and other sequelae.”
Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.
Thiruvengadam NR, Schaubel DE, Forde K, Lee P, Saumoy M, Kochman ML. Association of statin usage and the development of diabetes mellitus after acute pancreatitis. Clin Gastroenterol Hepatol. Published online June 21, 2022. doi:10.1016/j.cgh.2022.05.017