December 16, 2015
Statins along with aspirin and inhibitors of the renin-angiotensin-renin system are foundational to the treatment of atherosclerotic cardiovascular disease. The National Health and Nutrition Examination Study or NHANES reported that in 2011-2012, 23% of adults over the age of 40 reported using a statin medication.1 There is little doubt that statin treatment is effective in primary and secondary prevention of atherosclerotic cardiovascular disease.2-3 Furthermore, statins are generally safe and well tolerated.3 But are they?
When reviewing the literature, multiple studies show that statins can modestly raise blood sugar and more patients are diagnosed with diabetes on statins compared with those who are not taking these agents.4 There is one additional case of diabetes mellitus over four years when taking a statin. But compare this to a decrease of 5.4 cardiovascular events which were prevented so the pendulum swings to the reduction of cardiovascular events, even though statins cause diabetes in some individuals.
A new study shed more light on this important question. In 8,749 non-diabetic participants ages 45-73 (primarily white males), followed for almost six years, statin treatment was associated with increased type 2 diabetes of HR 1.46 (95% CI: 1.22-1.74).5 The risk was dose-dependent for simvastatin and atorvastatin (the two statins studied). Statin treatment increased two-hour glucose and glucose AUC on an oral glucose tolerance test. Insulin sensitivity and insulin secretion was reduced by 24% and 12%, respectively on statin treatment. Interestingly, those who developed diabetes mellitus were similar in baseline metabolic profiles to those who did not suggesting that statin treatment increases the risk of diabetes independently of the baseline risk profile of the population.
In those patients at risk of developing diabetes mellitus and/or cardiovascular events (Framingham Score, ASCVD Risk Estimator, etc…), the practitioner should have a risk-to-benefit discussion with the patient and determine together whether a statin is in the best interest of the patient. In addition, the patient should be started on a diet and exercise program. The importance of statins as part of the foundation of reducing cardiovascular disease events cannot be overemphasized, and statins should continue to be prescribed based on risk estimates.
Mark A. Munger, PharmD, FCCP, FACC, is a Professor of Pharmacotherapy and Adjunct Professor of Internal Medicine, at the University of Utah, where he also serves as the Associate Dean, Academic Affairs for the College of Pharmacy.
1. Gu Q, Paulose-Ram R, Burt VL, Kit BK. Prescription cholesterol-lowering medication use in adults aged 40 and over: United States, 2003-2012. NCHS Data Brief. 2014;(177):1-8.
2. Cholesterol Treatment Trialists (CTT) Collaborators, Kearney PM, Blackwell L, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371(9607):117-125.
3. Cholesterol Treatment Trialists (CTT) Collaborators, Baigent C, Blackwell L, et al. Efficacy and safety of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670-1681.
4. Shah RV, Goldfine AB. Statins and risk of new-onset diabetes mellitus. Circulation. 2012;126(18):e282-e284.
5. Cederberg H, Stančáková A, Yaluri N, Modi S, Kuusisto J, Laakso M. Increased risk of diabetes with statin treatment is associated with impaired insulin sensitivity and insulin secretion: a 6 year follow-up study of the METSIM cohort. Diabetologia.2015;58(5):1109-1117.