(137) Risk of sarcopenia following long-term statin use in community-dwelling middle-aged and older adults in Japan: evidence from a 10-year population-based cohort study using propensity score matching and overlap weighting

Background: Inconsistent results have been reported concerning the association between statin administration and muscle health, specifically its potential to increase the risk of sarcopenia. Given the widespread long-term use of statins among the elderly population, the exploration of this association remains a crucial yet insufficiently examined matter.

Objectives: To assess the association between the prolonged administration of statins and the risk of sarcopenia, diminished muscle strength, reduced skeletal muscle mass, and impaired physical performance

Methods: This population-based cohort study was conducted in Japan utilizing data derived from the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA). The study participants, enlisted from the 2nd to the 6th waves (spanning from April 2000 to July 2010) of the NILS-LSA, were those who aged 40 years or older and had initiated statin therapy (n=348). Individuals who were not administered statins were arbitrarily chosen using a combined approach of propensity score matching and risk set sampling to form the control group (with a 1:4 matching ratio, n=2554). The primary outcome of this study was the occurrence of sarcopenia, as defined by the 2019 consensus of the Asian Working Group for Sarcopenia (AWGS). The secondary outcomes included low muscle mass ( < 7.0 kg/m2 for men and below 5.4 kg/m2 for women by DXA), reduced skeletal muscle strength (handgrip strength < 28 kg in men and < 18 kg in women), and subpar physical performance (6-m walking speed < 1.0 m/second). To control for potential confounders, propensity score matching combined with risk set sampling was employed. The relationship between the long-term use of statins and the outcomes was estimated using a Cox proportional hazard model with time-varying covariates, which included the status of statin use and other variables in each wave. Stratification based on age and sex, along with several sensitivity analyses - including propensity score overlap weighting, competing risk analysis, intention to treat, and negative control - were conducted.

Results: The use of statins was not associated with an increased risk of incident sarcopenia (adjusted hazard ratio [aHR], 1.43 [95% CI, 0.86-2.36]), diminished muscle strength (aHR, 1.11 [95% CI, 0.80-1.54]), reduced muscle mass (aHR, 1.09 [95% CI,0.66-1.82]), or impaired physical performance (aHR, 0.73 [95% CI, 0.46-1.17]). These findings were consistent across age and sex stratifications, as well as all sensitivity analyses.

Conclusions: The results of our study indicate that the prolonged use of statins was not associated with an elevated risk of sarcopenia or impaired muscle health among individuals residing in Japanese communities.