Statins and Lower Gastrointestinal Conditions: A Retrospective Cohort Study

Abstract

Several studies have reported constipation, abdominal pain, or diarrhea as common adverse events for statins. Statins are among the most commonly prescribed medications, and the impact on the prevalence of these conditions was rarely studied as main outcomes. The aim of this study is to determine if statin therapy is associated with constipation, abdominal pain, diarrhea, or colitis. This was a retrospective cohort study using a regional military health care data from October 1, 2003, to March 1, 2012. A propensity score-matched cohort of statin users and nonusers was created based on 82 variables. The primary analysis evaluated the odds ratios of the following diagnoses: constipation, ≥3 encounters for constipation; abdominal pain, ≥3 encounters for abdominal pain; diarrhea, ≥3 encounters for diarrhea; colitis, ≥3 encounters for colitis; and endoscopy of the lower gastrointestinal tract, ≥3 endoscopies of the lower gastrointestinal tract. After propensity score matching of 6342 statin users and 6342 nonusers, there was no statistically significant difference in constipation (OR, 0.96; 95%CI, 0.87-1.05; P = .33), abdominal pain (OR, 0.95; 95%CI, 0.88-1.02; P = .15), or colitis (OR, 1.02; 95%CI, 0.91-1.14; P = .73). However, there was an association between statin therapy and endoscopy of the lower gastrointestinal tract (OR, 1.14; 95%CI, 1.04-1.26; P = .002) and decreased odds of diarrhea (OR, 0.88; 95%CI, 0.80-0.97; P = .01). In this retrospective cohort study, an association between statin therapy and increased likelihood of being diagnosed with lower gastrointestinal conditions could not be demonstrated, contrary to some statins package inserts.

Real-world data and evidence in pain research: a qualitative systematic review of methods in current practice

“…Based on our inclusion/exclusion criteria, through full-text screening, we identified 61 studies for inclusion. 1 , 3 , 6 – 8 , 11 , 13 – 15 , 21 , 22 , 24 – 31 , 34 – 41 , 44 – 46 , 49 – 61 , 63 – 67 , 69 – 73 , 75 , 78 – 80 , 82 – 84 , 87 We included no additional studies through reference search and 4 additional studies solicited from coauthors that were not otherwise included, 19 , 23 , 43 , 81 resulting in a total sample of 65 studies, all of which were published in the English language; hence, no studies were excluded based on language.…”

“…A list of all extraction items with summary statistics can be found in Table 1 . The studies identified were remarkably similar: 49 of 65 reported on surgical interventions; of the remaining16; 3 studied alternative treatments 8 , 25 , 29 ; 4 studied epidemiological risk factors like obesity, 22 old age, 21 opioid abuse, 23 and smoking 43 , 59 ; only 4 studies investigated pharmacological interventions 28 , 67 , 71 , 81 ; the remaining studied patient–professional–interaction or behavioural medicine, 19 , 66 radiotherapy, 49 implants, 69 or compared 2 disease progressions under routine care. 26 Of the 49 studies on surgical interventions, 23 focussed on postsurgical pain, with 3 investigating chronic postsurgical pain.…”

“…Only 17 of 65 studies provided sensitivity analyses to demonstrate robustness of their findings to violation of assumptions in the primary model. 1 , 11 , 14 , 23 – 25 , 27 , 29 , 30 , 52 , 56 , 66 , 67 , 71 , 79 – 81 …”

Associations between statins and adverse events in secondary prevention of cardiovascular disease: Pairwise, network, and dose-response meta-analyses of 47 randomized controlled trials

“…Studies indicated that statins tended to increase the risk of gastrointestinal discomfort or hemorrhage than other chronic medication users (93)(94)(95). Conversely, some studies did not show significant associations (96). The inconsistencies may result from varieties symptoms and severities of gastrointestinal discomfort.…”

Gender-specific association between the regular use of statins and the risk of irritable bowel syndrome: A population-based prospective cohort study

“…For instance, a propensity score-matched cohort study of 12,684 patients found that regular statin users had a lower prevalence of diarrhea and colitis, and statin use was associated with a decreased risk of diarrhea (Pearlman et al, 2017;Suchartlikitwong et al, 2018). In a randomized controlled phase 2a trial, a proprietary modified-release formulation of lovastatin lactone lowered breath methane levels and improved stool frequency in patients with IBS-C (Gottlieb et al, 2016), which further suggested the potential protective effects of statins on IBS development.…”