Receiving treatment with statins is associated with a decreased risk for postpancreatitis diabetes, 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 postpancreatitis diabetes 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.


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The primary outcome was postpancreatitis diabetes, and the end of follow-up was development of diabetes, death, loss to insurance follow-up, or June 31, 2021.

The cohort included 82,159 patients (median age, 58 [42-73] years; male, 47.1%) who did not use statins or any cholesterol-lowering medication before their diagnosis of acute pancreatitis (nonstatin users) and 9048 patients (median age, 74 [66-81] years; male, 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 (0.5-12.8) years.

In total, 12,590 (10.10%) patients developed postpancreatitis diabetes. The 5-year cumulative postpancreatitis diabetes incidence was 7.5% (95% CI, 6.9%-8.0%) in regular statin users and 12.65% (95% CI, 12.4%-12.9%) in nonusers (a difference of -5.2%; 95% CI, -7.4 to -4.3; P <.001).

Regular statin users had a 42% lower risk for postpancreatitis diabetes vs nonusers, with a hazard ratio (HR) of 0.58 (95% CI, 0.52-0.65; P <.001). Irregular statin users had a 15% lower risk for postpancreatitis diabetes compared with statin nonusers (HR, 0.85; 95% CI, 0.81-0.89; P <.001).

Multivariable-adjusted HRs for postpancreatitis diabetes based on the defined daily statin dose, compared with no statin use, were 0.45 (95% CI, 0.36-0.57; P <.001) for a dose of 0.01 to 0.75 defined daily dose, 0.58 (95% CI, 0.49-0.70; P <.001) for 0.76 to 1.50 defined daily dose, and 0.70 (95% CI, 0.56-0.89; P <.001) for higher than 1.50 defined daily dose.

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 nonusers. Regular statin users had a 52% decreased risk for insulin-dependent diabetes vs nonusers (HR, 0.48; 95% CI, 0.41-0.56; P <.001).

The researchers noted that they did not have information regarding radiologic findings, inpatient treatments and specific severity grade of pancreatitis, screening for diabetes, and whether or how the patients took the statins. Also, treatment-related selection bias is possible, and statin use may be a marker of increased health awareness, creating a healthy-user bias.

“Among patients with [acute pancreatitis], we observed an association between statin use at the time of presentation and a reduced risk of [postpancreatitis diabetes], 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 [postpancreatitis diabetes] 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 authors’ disclosures.

Reference

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

This article originally appeared on Gastroenterology Advisor