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. 2023 Jul 14;11(7):23259671231167851.
doi: 10.1177/23259671231167851. eCollection 2023 Jul.

Effects of Statin Treatment on the Development of Tendinopathy: A Nationwide Population-Based Cohort Study

Donghee Kwak  1 , Seok-Joo Moon  2 , Jong Woong Park  1 , Duk Hee Lee  3 , Jung Il Lee  4
Affiliations

Effects of Statin Treatment on the Development of Tendinopathy: A Nationwide Population-Based Cohort Study

Donghee Kwak et al. Orthop J Sports Med. .

Abstract

Background: Previous longitudinal cohort studies have reported the conflicting results of the relationship between statin use and the development of tendinopathy disorder. It is unclear if there is a relationship between statin use, particularly the type or cumulative doses, and the development of tendinopathy disorder.

Purpose: To investigate an association between statin treatment and the development of tendinopathy.

Study design: Cohort study; Level of evidence, 3.

Methods: A total of 594,130 participants were enrolled in this study in 2002 and evaluated until 2015. There were 84,102 statin users and 168,204 nonusers (controls) selected at a ratio of 1:2 using propensity score matching analysis. The types of included tendinopathy were as follows: (1) trigger finger, (2) radial styloid tenosynovitis, (3) elbow epicondylitis, (4) rotator cuff tendinopathy, and (5) Achilles tendinitis. Cox proportional hazards models with time-varying covariates were constructed to identify the association between statin use and tendinopathy development.

Results: Statin treatments regardless of statin types were associated with a significantly greater risk of all types of tendinopathy development (hazard ratio, 1.435; 95% CI, 1.411-1.460) compared with no statin treatment. A trend toward risk reduction was observed according to cumulative statin doses, which was indicated by hazard ratios of 2.337 (95% CI, 2.269-2.406), 2.210 (95% CI, 2.132-2.290), and 1.1 (95% CI, 1.098-1.146) in patients with cumulative defined daily doses of 90, 91-180, and >180, respectively.

Conclusion: This nationwide population-based cohort study suggests that statin use regardless of the statin type was associated with a greater risk of tendinopathy compared with that of nonusers. The risk of tendinopathy development was diluted with the increasing cumulative defined daily dose.

Keywords: cohort study; dyslipidemia; statin; tendinitis; tendinopathy; tendon.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by a grant from the National Research Foundation of Korea funded by the Korean government (MSIT) (grant No. NRF-2020R1C1C1004851). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flow diagram of the patient selection process. a Other statins included pitavastatin, pravastatin, lovastatin, and fluvastatin. NHIS, National Health Insurance Service.
Figure 2.
Figure 2.
Standardized mean differences in the baseline characteristics for the entire cohort and matched cohort. CKD, chronic kidney disease; DM, diabetes mellitus; PSM, propensity score matching.
Figure 3.
Figure 3.
Cumulative incidence of the tendinopathy in matched cohort patients (statin users vs nonusers). (A) Overall, (B) by statin type, and (C) by cumulative doses of statin. a Pitavastatin, pravastatin, lovastatin, or fluvastatin. cDDD, cumulative defined daily dose.
Figure 4.
Figure 4.
Forest plot portraying the hazard ratios and 95% CIs of the association between statin use and tendinopathy development according to statin use, cumulative defined daily dose (cDDD) of statin, and statin type for (A) trigger finger, (B) radial styloid tenosynovitis, (C) elbow epicondylitis, (D) shoulder tendinopathy, and (E) Achilles tendinopathy. *Pitavastatin, pravastatin, lovastatin, or fluvastatin
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References

    1. Bakker EA, Timmers S, Hopman MTE, Thompson PD, Verbeek ALM, Eijsvogels TMH. Association between statin use and prevalence of exercise-related injuries: a cross-sectional survey of amateur runners in the Netherlands. Sports Med. 2017;47(9):1885–1892. - PMC - PubMed
    1. Beri A, Dwamena FC, Dwamena BA. Association between statin therapy and tendon rupture: a case-control study. J Cardiovasc Pharmacol. 2009;53(5):401–404. - PubMed
    1. Bruckert E, Hayem G, Dejager S, Yau C, Bégaud B. Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients—the PRIMO study. Cardiovasc Drugs Ther. 2005;19(6):403–414. - PubMed
    1. Carmont MR, Highland AM, Blundell CM, Davies MB. Simultaneous bilateral Achilles tendon ruptures associated with statin medication despite regular rock climbing exercise. Phys Ther Sport. 2009;10(4):150–152. - PubMed
    1. Chazerain P, Hayem G, Hamza S, Best C, Ziza JM. Four cases of tendinopathy in patients on statin therapy. Joint Bone Spine. 2001;68(5):430–433. - PubMed

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