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Can Statins increase the Risk of Skin Infection?

Dec 14, 2019
 
Editor: Steve Freed, R.PH., CDE

Author: Andrew Daoud, PharmD Candidate, Florida A&M University

New research attempts to untangle the conflicting literature on whether statins and SSTIs are linked.

Bacteria typically invade a person’s defense system when it is compromised, such as when the skin breaks. Indeed, the major cause of bacterial skin and soft tissue infections (SSTIs) is staphylococcus aureus; these can be either superficial or serious infections and are found amongst different age groups (Ko, Lareu, Dix, Hughes, & Parsons 2559). The formation of SSTIs is usually as a result of the bacteria overrunning the defense system and creating or developing inflammation in the surrounding tissues. The researchers aimed to determine the impact of statins on the risk of skin infection despite conflicting literature, where on the one hand, statins may reduce infection risk and, on the other hand, statins are connected to diabetes mellitus, which is a risk factor for STTIs (Ko et al. 2559). These conflicting postulations are at the heart of the study. Here, it is necessary to note that statins are a class of drugs that can assist in lowering the level of cholesterol and have a wide array of uses.

The study uses the sequence symmetry analysis (SSA) method to determine which of the hypotheses mentioned above is visible when this method is used. The data is obtained from the Australian Department of Veterans’ Affairs (DVA). The authors defend their use of the SSA method over other epidemiological study designs, arguing that it controls the confounding factors such as age, sex, and genetics, which did not have a significant difference during the period of study (Ko et al. 2560). Data sources were derived from seeking the permission of DVA to study prescription claims made by over 228,000 veterans, war widows and widowers for 12 years. The researchers used the derived data in three stages, which are: primary analysis, confirmatory analysis, and secondary analysis.

The results of the study are grouped into the level of analyses mentioned above. For the primary analysis, the results reveal that there was a great risk of SSTIs when statins were used and that increased levels of SSTIs were found in patients with diabetes. For the confirmatory analysis, the results indicate that users without diabetes were found to have significant SSTI risk and that statin users with diabetes were also determined to have significant levels of SSTIs. Also, for confirmatory analysis, it was established that users without diabetes have significant SSTI risks, and those statin users with diabetes were linked to similar associations of significant SSTI risks. 

Moreover, the authors contend that at present, there is a dearth of research examining the risks of SSTIs that emanate from statins. Yet, despite this, there are conflicting conclusions regarding the effect of statins on the risk of general infections, where, on the one hand, there are those who support the argument that statins reduce the risk of general infections and on the other those refuting this argument. In effect, the authors state that it is necessary to reconcile these arguments with the available literature; clinical outcomes would probably align with the results of the study to ensure action against SSTIs (Humphrey et al. 2561).  A second issue that the authors sought to establish was statins and the risk of diabetes, in which the study revealed that statin exposure risk peaked after 91 days. A third issue was about statins and the immune system, where it was revealed that statin users are likely to be influenced by pathogenic infections such as SSTIs; yet it remains unclear what is the overall impact of lowering cholesterol on the skin, and this is an area further research can explore. Lastly, in surmising the healthy user effect, the authors observed that the health-conscious individuals would be more inclined to preventive healthcare, such as by consuming healthy foods.

Also, the study’s limitations were that other available antibiotics can be used to treat SSTIs and that there are other conditions besides elevated waist circumference and elevated blood pressure that may impact on the risks associated with SSTIs. As a result, the article concludes by noting statins can increase SSTIs risk via a direct and indirect mechanism. Consequently, further studies are needed to examine the effects of statin factors such as skin function inhibited by cholesterol and impaired bile acid metabolism. 

Practice Pearls:

  • This study found statins users with or without diabetes have increased levels of risk for SSTIs.
  • To date, there is conflicting research on whether statins reduce the risk of general infections or not.
  • The overall impact on the skin of lowering cholesterol remains unclear and is an area for further research.

Ko, Humphrey, T., Lareu, Ricky, R., Dix, Brett., Hughes, Jeffery, D. and Parsons, Richard, W. “A Sequence Symmetry Analysis of the Interrelationships Between Statin, Diabetes and Skin Infections.” British Journal of Clinical Pharmacology, vol. 85, no. 11, 2019, https://doi.org/10.1111/bcp.14077. Accessed 29 November 2019. 

Andrew Daoud, PharmD. Candidate of Florida Agricultural & Mechanical University School of Pharmacy