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Calorie, fat intake increased over time among statin users
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A new report describes an increase in caloric and fat intake from 1999 to 2010 among adults who use statins. However, the same trend was not observed among statin nonusers.
In addition, Takehiro Sugiyama, MD, MSHS, and colleagues found that adult participants in the National Health and Nutrition Examination Survey who used statins had a greater increase in BMI from 1999 to 2010 compared with nonusers.
“Efforts aimed at dietary control among statin users may be becoming less intensive,” Sugiyama, from the University of California, and colleagues wrote in JAMA Internal Medicine. “The importance of dietary composition may need to be re-emphasized for statin users.”
The researchers conducted a repeated cross-sectional study of 27,886 NHANES participants aged 20 years or older using data from 1999 to 2010. The primary outcomes, caloric and fat intake, were assessed by 24-hour dietary recall interviews. Secondary outcomes included BMI and levels of LDL and total cholesterol.
More calories consumed by statin users
In the first survey during the study period, NHANES 1999-2000, caloric intake was lower for statin users than for nonusers (2,000 kcal/day vs. 2,107 kcal/day; P=.007). However, the difference became smaller with each subsequent survey, and there was no significant difference between statin users and nonusers by NHANES 2005-2006 (2,142 kcal/day vs. 2,183 kcal/day; P=.29), the researchers found.
Among statin users, caloric intake in 2009-2010 was 9.6% higher (95% CI, 1.8-18.1; P=.02) than in 1999-2000, but there was no significant change for statin nonusers between those periods (–1.9%; 95% CI, –4.6 to 0.9).
In 1999 to 2000, fat intake was lower among statin users than nonusers (71.7 g/day vs. 81.2 g/day; P=.003), but the difference ceased to be significant by the 2003-2004 survey (79.5 g/day vs. 84.3 g/day; P=.09).
Fat intake increased 14.4% among statin users (95% CI, 3.8-26.1; P=.007) from 1999 to 2010, but did not change significantly among statin nonusers during that time (–2.3%; 95% CI, –5.6 to 1.1).
BMI increased by 1.3 kg/m2 among statin users during the study period vs. an increase of 0.4 kg/m2 among nonusers (P=.02).
Time trends of total cholesterol and LDL levels significantly differed by statin use (P<.001 for both), according to the researchers. Total cholesterol in the statin group declined from 193.4 mg/dL in 1999-2000 to 171.4 mg/dL in 2009-2010 vs. a decline from 205.1 mg/dL in 1999-2000 to 200.8 mg/dL in 2009-2010 for the non-statin group. LDL in the statin group declined from 113.3 mg/dL in 1999-2000 to 95.8 mg/dL in 2009-2010 vs. a decline from 127.3 mg/dL in 1999-2000 to 120.7 mg/dL in 2009-2010 for the non-statin group.
“Particularly in a time when obesity and diabetes have become epidemics and US health care costs have been soaring, we need to consider if it is an acceptable public health strategy to encourage statin use without also taking measures to decrease the likelihood that its use will be associated with increased caloric and fat intake as well as weight gain,” Sugiyama and colleagues wrote.
“We believe that the goal of statin treatment, as with any pharmacotherapy, should be to allow patients to decrease risks that cannot be decreased without medication, not to empower them to put butter on their steaks,” they wrote.
‘False reassurance’
Rita F. Redberg
In an editor’s note, Rita F. Redberg, MD, MSc, professor of medicine at the University of California, San Francisco, and chief editor of JAMA Internal Medicine, wrote that “for many patients, statins provide a false reassurance, as people seem to believe that statins can compensate for poor dietary choices and a sedentary life.”
The study “raises concerns of a potential moral hazard of statin use, in addition to the already known adverse effects,” Redberg, a member of the Cardiology Today Editorial Board, wrote. “Focusing on cholesterol levels can be distracting from the more beneficial focus on healthy lifestyle to reduce heart disease risk.”
For more information:
Redberg RF. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.1994.
Sugiyama T. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.1927.
Disclosure: The researchers and Redberg report no relevant financial disclosures.