Statins Boost Risk of Diabetes

Everything has a cost, they say. When it comes to the ‘miracle’ of pharmaceuticals – statins, there are a number of risks that go along with their ability to reduce lipids. One of these risks is type 2 diabetes. Statins have been associated with developing diabetes.

Risk of diabetes and statins

In a review of the research connecting diabetes and statins, Scripps Research Institute scientist and cardiologist Dr. Eric Topol documents that the more potent statins increase the risk of diabetes at higher levels.

While the risk stated by the Food and Drug Administration was characterized as “small,” Dr. Topel defines this statement as “ambiguous,” because it fails to differentiate between the effects of the more moderate statins such as Pravachol and Mevacor, and those of the stronger statins, which include Crestor (rosuvastatin), Zocor (simvastatin) and Lipitor (atorvastatin).

In his Op-ed piece in the New York Times, Dr. Topel illustrates that these moderate statins produce very minimal increased risk of diabetes, while the stronger more potent versions produce clear risk increases. Dr. Topel indicates that the FDA is netting out those risks when characterizing them as “small.”

The 2010 research, which pooled multiple studies involving 91,000 patients treated either with any statin or a placebo, found on average that diabetes risk increased to one in 255 patients. However, when the analysis is focused on one of the stronger statins, the risk increases substantially, to one in 167 for those taking 20 milligrams of Crestor, and as high as one in 125 for intensive treatments to reduce cholesterol. And this is using treatments that have been taken for five years at the most.

Today, over 20 million Americans take statins. Using this number, if the risk was only 1 in 200 – much lower than the 1 in 125 or 1 in 167 found among the stronger statins – then this is producing 100,000 new cases of diabetes per year according to Dr. Topel’s calculations.

As astonishing as this number is, these are still conservative, given that many statin patients have been on the drug for a decade or more, and often at dosages greater than 20 milligrams.

Dr. Topol continued: “If there were a major suppression of heart attacks or strokes or deaths, that might be justified. But in patients who have never had heart disease and are taking statins to lower their risk (so-called primary prevention), the reduction of heart attacks and other major events is only 2 per 100. And we don’t know who the 2 per 100 patients are who benefit or the one per 200 who will get diabetes! Moreover, the margin of benefit to risk is quite narrow.”

Dr. Topal advises patients to talk to their doctors about their statin prescriptions: “But in the vast majority of people who take statins — those who have never had any heart disease — there should be a careful review of whether the statin is necessary, in light of the risk of diabetes and the relatively small benefit that can be derived. Beyond that, a dose reduction or use of a less potent statin should be considered on an individual basis.”

Statin use is also associated with cognitive decline according to other research.

Statins increase diabetes risk among women

Researchers from the University of Massachusetts School of Medicine have found that statin pharmaceuticals significantly increase the risk of type 2 diabetes among older women.

The study, led by Yunsheng Ma, MD, PhD, analyzed data from the Women’s Health Initiative studies. This found that postmenopausal women who took statin drugs – used for lowering cholesterol – had close to 50% increased risk of type 2 diabetes compared to those not taking statins.

Statins are a class of drugs that include atorvastatin (brand name Lipitor) and simvastatin (brand name Zocor).

Dr. Ma commented that, “This study urges us to further evaluate the risk-benefit profile of statins.”

This isn’t the first study that found the connection between statin drugs and diabetes. A 2011 review of 76 clinical trials that included 170,255 human participants found a 9% increased risk of diabetes among statin users overall.

This newest study from the Women’s Health Initiative utilized data from 153,840 women with an average age of 63 years old. They did not have diabetes when they enrolled in the study, and 7% were taking statins at that point. By 2005, 10,242 of the women had contracted diabetes.

Initially, the increase in risk was calculated at 71%. But after eliminating associations related to weight, age and race, the final increased risk was 48%. Asian women had the highest increase in risk, with 78%, while Hispanic women experienced a 57% increased risk.

Dr. Ma commented that the increased risk was across the board among all statin pharmaceutical types.

Dr. Ma added that statins are being over-prescribed. “Too many people are put on a statin who don’t have to be.”

Red yeast rice (Monascus purpureus), a natural form of statin, was not tested.

A number of natural foods and herbs have been shown to significantly reduce cholesterol. Red yeast rice reduces cholesterol better than statins according to other research.

Learn more about heart-healthy foods:

 

REFERENCES:

Mills EJ, Wu P, Chong G, Ghement I, Singh S, Akl EA, Eyawo O, Guyatt G, Berwanger O, Briel M. Efficacy and safety of statin treatment for cardiovascular disease: a network meta-analysis of 170,255 patients from 76 randomized trials. QJM. 2011 Feb;104(2):109-24.

Topol E. The Diabetes Dilemma for Statin Users. NY Times, 2012: Op-Ed, 4 Mar.

Annie L. Culver, Ira S. Ockene, Raji Balasubramanian, Barbara C. Olendzki, Deidre M. Sepavich, Jean Wactawski-Wende, JoAnn E. Manson, Yongxia Qiao, Simin Liu, Philip A. Merriam, Catherine Rahilly-Tierny, Fridtjof Thomas, Jeffrey S. Berger, Judith K. Ockene, J. David Curb, and Yunsheng Ma. Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women’s Health Initiative. Arch Intern Med. 2012;0(2012):20116252-9.