Statin treatment is not associated with an increased risk of adrenal insufficiency in real-world setting

Sandy Maumus-Robert; Ana Jarne-Munoz; Antoine Pariente; Thomas Duroux; Lise Duranteau; Julien Bezin

doi:10.3389/fendo.2023.1254221

Statin treatment is not associated with an increased risk of adrenal insufficiency in real-world setting

Front Endocrinol (Lausanne). 2023 Sep 25:14:1254221. doi: 10.3389/fendo.2023.1254221. eCollection 2023.

Authors

Sandy Maumus-Robert¹, Ana Jarne-Munoz¹, Antoine Pariente^{1

2}, Thomas Duroux³, Lise Duranteau⁴, Julien Bezin^{1

2}

Affiliations

¹ University Bordeaux, INSERM, Bordeaux Population Health (BPH), Team AHeaD, Bordeaux, France.
² CHU de Bordeaux, Clinical Pharmacology Unit, INSERM, Bordeaux, France.
³ Health Information Department, ELSAN Group, Paris, France.
⁴ Medical Gynaecology Department, AP-HP Paris Saclay University, Bicêtre Hospital, Paris, France.

Abstract

Introduction: Statins could reduce the synthesis of steroid hormones, thereby could cause adrenal insufficiency. We investigated this risk in a large nationwide database.

Methods: We conducted a nested case-control study using a cohort of individuals affiliated to the French health insurance system in 2010, ≥18y and without adrenal insufficiency history. Each case had a first event of adrenal insufficiency between 2015 and 2017 and was matched to up to ten controls on age, sex, and prior treatment with corticosteroids. Statin exposure was measured over the five years preceding the index date, considering a six-month censoring lag-time. Association was estimated using a conditional logistic regression adjusted for confounders included in a disease risk score. Analyses were stratified on age, sex and corticosteroid history of use.

Results: 4 492 cases of adrenal insufficiency were compared with 44 798 controls (median age 66y, 58% women), of which 39% vs. 33% were exposed to statins, respectively. No association between statin use and adrenal insufficiency was found when adjusting the model for confounders (adjusted odds ratio 0.98; 95% confidence interval 0.90-1.05). These results were consistent regardless of the exposure definition and stratifications considered.

Conclusion: Statin-related adrenal insufficiency risk, if any, seems to be very limited and does not compromise the benefit of statin treatment.

Keywords: adrenal insufficiency; database; pharmacoepidemiology; risk; statins.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / adverse effects
Adrenal Insufficiency* / chemically induced
Adrenal Insufficiency* / epidemiology
Aged
Case-Control Studies
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects
Male
Risk Factors

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Adrenal Cortex Hormones

Grants and funding

This work was supported by the French Medicines Agency (Agence Nationale de Sécurité du Médicament et des Produits de Santé, ANSM) (grant number 2019S015), in the context of a partnership with the Health Product Epidemiology Scientific Interest Group (EPI-PHARE). The ANSM played no role in the study design, conduct, and results interpretation or discussion. This publication represents the views of the authors and does not necessarily represent the opinion of the ANSM.