Study Suggests Musculoskeletal Conditions, Injuries, and Pain More Prevalent among Patients Using Statins
BACKGROUND:
Statins effectively lower cardiovascular morbidity and mortality, yet the full spectrum of adverse events related to statin use is unknown. This retrospective cohort study sought to determine whether statin use was associated with musculoskeletal conditions, including arthropathy (joint disease) and injury. Investigators identified a cohort of statin users and non-users among active duty soldiers, Veterans, and their families, who were Tricare Prime/Plus beneficiaries (30-85 years old) between 10/03 and 3/10. Tricare is a military healthcare system. Participants were categorized into two treatment groups: statin users (n=13,626), who received and filled a statin medication for at least 90 days from 10/04 to 9/05, and non-users (n=32,623), who did not receive a statin at any time throughout the study period. Investigators then used propensity scores to match 6,967 statin users with 6,967 non-users. In addition to comparing the occurrence of musculoskeletal conditions between the matched statin users and non-users, investigators examined patient demographics, comorbidities, healthcare utilization, and medication use.
FINDINGS:
- Musculoskeletal conditions, injuries, and pain were more common among statin users than similar non-users in the propensity matched group.
- In secondary and sensitivity analyses of the overall cohort and subgroups with no comorbidities, those with no pre-existing musculoskeletal conditions, and those who used statins for at least 2 years, results were the same. In addition, arthropathy was found to be more common among statin users than non-users.
LIMITATIONS:
- ICD-9-CM codes were used to identify baseline characteristics and statin-associated adverse events, which may lack sensitivity toward some variables. Also, ICD-9-CM codes do not provide information on severity of illness.
- The use of pharmacy data to account for medication use assumes, but cannot ascertain, that patients are actually taking their medications. However, 88% of the statin users in this study filled their prescriptions for two years, which may be considered a surrogate marker for actual use.
IMPLICATIONS:
- These findings are concerning, since starting statins at a young age for primary prevention of cardiovascular diseases has been widely advocated.
- Active duty soldiers and Veterans have been reported to have a high prevalence of musculoskeletal diseases that exceeds that of the general population, which may be related to their strenuous muscular activity. The increased risk of injury in this population suggests that statin therapy may compromise soldiers' musculoskeletal preparedness.
AUTHOR/FUNDING INFORMATION: This is not VA funded, but Dr. Pugh is part of HSR&D's Veterans Evidence-Based Research, Dissemination, and Implementation Center (VERDICT) in San Antonio, TX, and the South Texas Veterans Health Care System.
Mansi I, Frei CR, Pugh MJ, et al. Statins and Musculoskeletal Conditions, Arthropathies, and Injuries. JAMA Internal Medicine July 22, 2013;173(14):1318-26.
