If you’re like nearly one-third of Americans over age 40, you probably take a statin. These cholesterol-lowering drugs are used for reducing risk of stroke and heart attack. They work by lowering the amount of LDL cholesterol, the so-called “bad cholesterol” in the blood. Statins also reduce inflammation around plaque in the blood vessels.
Despite their benefits, some people stop taking them because of side effects. The latest example, which is shown in numerous studies suggest that taking statins could increase the risk of developing type 2 diabetes. “Nobody expected it,” says Om Ganda, M.D., Director of the Lipid Clinic at Joslin Diabetes Center.
In response to this mounting evidence, Dr. Ganda carried out a comprehensive review of all available evidence examining the association between statins and type 2 diabetes. The new review showed largely consistent results across 33 randomized controlled trials and observational studies.
“There does seem to be a slight, but significant increase in the risk of new-onset diabetes in patients on statin therapy,” says Dr. Ganda.
Of the 33 studies included in the review, one study found that taking statins was linked to a 25 percent higher risk of diabetes. However, the other studies revealed either no increase or a much smaller increase (2 to 10 percent) with various statins.
Dr. Ganda says that it’s important to note that the increased risk is over and above the risk people already have, because diabetes and prediabetes are so common today.
The review also showed that the highest risks are associated with the most intensive statin therapy. It appears that those on high-dose statins, which have a greater effect at lowering cholesterol, are more likely to develop diabetes than those on moderate-dose statins.
“The risk of diabetes is dependent on the dose of the statin – that is, how strong it is — and the correlation seems to be significant,” says Dr. Ganda. “But still, more intensive therapy is indicated because of all the evidence that we have, particularly in patients who already have cardiovascular disease.”
The reason behind the statin-induced diabetes remains unclear. “The cumulative evidence does show that most people who get diabetes on statins already have prediabetes or features of metabolic syndrome, he explains. “This means that starting statin therapy just ushers it in.”
What to Think About
If you’re concerned about preventing diabetes from happening, adopting a healthier lifestyle is the first step. If you’ve been diagnosed with prediabetes and have to go on statin therapy, talk to your doctor about doing whatever is necessary to control or reverse your prediabetes. In general, that means staying active, eating a heart-healthy diet and controlling your weight.
“People should be educated about their choices,” says Dr. Ganda. “The results from this review provides yet another reason for people to monitor their diet and get regular exercise.”
Should You Avoid Statins?
Despite the slight increase in diabetes risk from using statin drugs, this alone is not enough to avoid taking them, Dr. Ganda points out. “It’s important for people with diabetes not to stop initial statin therapy, because it lowers the risk of cardiovascular disease.”
Instead, he explains, statin therapy should be intensified in order to get LDL as low as possible. As we get older, our LDL cholesterol usually rises, probably due to an increase in body fat. This harmful cholesterol is what produces atherosclerosis, the buildup of plaque in the inner linings of arteries that restricts blood flow. The goal should be an LDL level below 100, closer to 70 if you have heart disease “This benchmark is stricter than it used to be because many trials have shown that the lower you get LDL cholesterol the better,” he says.
When these studies first came out some experts said that statins should not be used in the diabetes population, but that is the wrong approach, he adds. “There is no reason to avoid statins out of fear of developing diabetes. And those who do develop diabetes on statin therapy are still protected against cardiovascular disease, even after developing diabetes.”
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