Annie L. Culver

Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative

BACKGROUND This study investigates whether the incidence of new-onset diabetes mellitus (DM) is associated with statin use among postmenopausal women participating in the Womens Health Initiative (WHI). METHODS The WHI recruited 161,808 postmenopausal women aged 50 to 79 years at 40 clinical centers across the United States from 1993 to 1998 with ongoing follow-up. The current analysis includes data through 2005. Statin use was captured at enrollment and year 3. Incident DM status was determined annually from enrollment. Cox proportional hazards models were used to estimate the risk of DM by statin use, with adjustments for propensity score and other potential confounding factors. Subgroup analyses by race/ethnicity, obesity status, and age group were conducted to uncover effect modification. RESULTS This investigation included 153,840 women without DM and no missing data at baseline. At baseline, 7.04% reported taking statin medication. There were 10,242 incident cases of self-reported DM over 1,004,466 person-years of follow-up. Statin use at baseline was associated with an increased risk of DM (hazard ratio [HR], 1.71; 95% CI, 1.61-1.83). This association remained after adjusting for other potential confounders (multivariate-adjusted HR, 1.48; 95% CI, 1.38-1.59) and was observed for all types of statin medications. Subset analyses evaluating the association of self-reported DM with longitudinal measures of statin use in 125,575 women confirmed these findings. CONCLUSIONS Statin medication use in postmenopausal women is associated with an increased risk for DM. This may be a medication class effect. Further study by statin type and dose may reveal varying risk levels for new-onset DM in this population.

Single-Component Versus Multicomponent Dietary Goals for the Metabolic Syndrome: A Randomized Trial

Background Few studies have compared diets to determine if a program focused upon one dietary change results in collateral effects on other untargeted healthy diet components.

Elevated depressive symptoms, antidepressant use, and diabetes in a large multiethnic national sample of postmenopausal women

OBJECTIVE To examine elevated depressive symptoms and antidepressant use in relation to diabetes incidence in the Women’s Health Initiative. RESEARCH DESIGN AND METHODS A total of 161,808 postmenopausal women were followed for over an average of 7.6 years. Hazard ratios (HRs) estimating the effects of elevated depressive symptoms and antidepressant use on newly diagnosed incident diabetes were obtained using Cox proportional hazards models adjusted for known diabetes risk factors. RESULTS Multivariable-adjusted HRs indicated an increased risk of incident diabetes with elevated baseline depressive symptoms (HR 1.13 [95% CI 1.07–1.20]) and antidepressant use (1.18 [1.10–1.28]). These associations persisted through year 3 data, in which respective adjusted HRs were 1.23 (1.09–1.39) and 1.31 (1.14–1.50). CONCLUSIONS Postmenopausal women with elevated depressive symptoms who also use antidepressants have a greater risk of developing incident diabetes. In addition, longstanding elevated depressive symptoms and recent antidepressant medication use increase the risk of incident diabetes.

Statin therapy and the risk for diabetes among adult women: do the benefits outweigh the risk?

Purpose of review: The purpose of this review was to examine statin therapy and the risk for diabetes among adult women using a selective review. Recent findings: The literature contains reports of new-onset diabetes associated with statin use. While many studies do not report sex-specific results, there is evidence indicating the risk to benefit ratio may vary by gender. However, the absolute effects are not clear because women have historically been under-represented in clinical trials. Summary: A review of the literature indicates that the cardiovascular benefits of statins appear to outweigh the risk for statin-related diabetes. However, the effect may depend upon baseline diabetes risk, dose, and statin potency. Rigorous, long-term studies focused on the risks and benefits of statins in women are unavailable to sort for gender-specific differences. Until this changes, individualized attention to risk assessment, and strong prevention with lifestyle changes must prevail.

Relations of Depressive Symptoms and Antidepressant Use to Body Mass Index and Selected Biomarkers for Diabetes and Cardiovascular Disease

OBJECTIVES We investigated whether depressive symptoms and antidepressant use are associated with biomarkers for glucose dysregulation and inflammation, body mass index (BMI), and waist circumference. METHODS Postmenopausal women were recruited into the Womens Health Initiative from 1993 to 1998, and data were collected at regular intervals through 2005. We used multiple linear regression models to examine whether depressive symptoms and antidepressant use are associated with BMI, waist circumference, and biomarkers. RESULTS Analysis of data from 71, 809 women who completed all relevant baseline and year 3 assessments showed that both elevated depressive symptoms and antidepressant use were significantly associated with higher BMI and waist circumference. Among 1950 women, elevated depressive symptoms were significantly associated with increased insulin levels and measures of insulin resistance. Analyses of baseline data from 2242 women showed that both elevated depressive symptoms and antidepressant use were associated with higher C-reactive protein levels. CONCLUSIONS Monitoring body habitus and other biomarkers among women with elevated depression symptoms or taking antidepressant medication may be prudent to prevent diabetes and cardiovascular disease.

A simple dietary message to improve dietary quality: Results from a pilot investigation

OBJECTIVE The present study compared the feasibility of two simple messages (a high-fiber diet or a low saturated fat diet) to a combination message (high fiber/low saturated fat) on their potential to affect dietary quality and metabolic health. METHODS Thirty-six subjects were randomized to one of three intervention conditions and received individual dietary counseling sessions. Study assessments occurred at baseline, 3 mo, and 6 mo. RESULTS The sample was 84% female and 94% Caucasian. Mean body mass index was 31kg/m(2). At the 6-mo assessment phase, we retained all 12 patients in the high-fiber diet condition, 10 of 12 in the low saturated fat condition, and 9 of 12 in the combination condition. Participants reported that the dietary fiber intervention was easier to maintain compared with the other two intervention conditions (83% for high dietary fiber versus 60% for low saturated fat versus 33% for the combination, P=0.008). Overall dietary quality improved in all three conditions during the study (P=0.01). In addition to increasing fiber, the high-fiber condition decreased their saturated fat intake, even though a reduction in saturated fat was not a part of that intervention condition. Participants in all three conditions lost an average of 9 lb from baseline weight (P<0.001). CONCLUSION A simple dietary message is feasible and can improve overall dietary quality. Results support the need for a larger randomized controlled trial that is powered to detect the efficacy of a simplified dietary recommendation for dietary quality and metabolic health.

Single-Component Versus Multicomponent Dietary Goals for the Metabolic SyndromeA Randomized TrialComparison of High-Fiber and AHA Diets

Background Few studies have compared diets to determine if a program focused upon one dietary change results in collateral effects on other untargeted healthy diet components.

A randomized trial of single- versus multi-component dietary goals for metabolic syndrome

Background Few studies have compared diets to determine if a program focused upon one dietary change results in collateral effects on other untargeted healthy diet components.