Statins Are Associated with Urinary Tract Infections
Based on recent observational evidence, statins appear to be associated with an increased risk of UTIs, particularly in patients with type 2 diabetes, though this association is not mentioned in major statin safety guidelines.
Evidence for the Association
The most relevant recent study 1 examined newly prescribed medications in patients with type 2 diabetes prior to UTI diagnosis and found statins were the second most commonly prescribed medication class before UTI events (3.42 percentage point difference, p<0.001). This ranked statins higher than SGLT2 inhibitors, which are traditionally considered the primary medication-associated UTI risk in diabetic patients.
However, this finding requires careful interpretation:
- The association does not establish causation - patients receiving statins may have more comorbidities or healthcare encounters that independently increase UTI risk
- The study population was limited to patients with type 2 diabetes, who already have elevated baseline UTI risk
- One earlier study 2 examining respiratory infections found statins were associated with reduced UTI risk (OR 0.91,95% CI 0.85-0.98), though this was a secondary outcome
Guideline Perspective
Major statin safety guidelines 3, 4 do not list UTIs as a recognized adverse effect. These comprehensive Canadian and ACC/AHA guidelines from 2002-2013 extensively detail statin adverse effects including:
- Myopathy and rhabdomyolysis
- Hepatic transaminase elevation
- New-onset diabetes
- Renal effects (hematuria, proteinuria, microalbuminuria)
The absence of UTI mentions in these authoritative safety reviews suggests this is not a well-established or clinically significant adverse effect.
Clinical Implications
Do not avoid or discontinue statins due to UTI concerns. The cardiovascular mortality benefits of statins far outweigh any potential UTI association. If a patient on statins develops recurrent UTIs:
- Investigate standard UTI risk factors (diabetes control, urinary retention, anatomical abnormalities, sexual activity)
- Consider other recently initiated medications that may contribute (opioids, PPIs, antibiotics)
- Continue statin therapy unless other compelling reasons for discontinuation exist
Special Population: ESKD Patients
One study 5 found increased upper tract urothelial carcinoma (UTUC) risk in statin users with end-stage kidney disease (sHR 1.98), but this addresses cancer risk, not UTI risk, and represents a distinct clinical concern in a highly specific population.