Cholesterol lowering statin drugs have gotten a lot press in recent weeks. A study just released in the Annals of Internal Medicine suggests that everyone over the age of 75 should take statins as a preventive measure against heart attacks and other heart events. Plus, new guidelines by the American Diabetes Association suggest giving statins to nearly everyone with diabetes as a preventive measure against cardiac events
Yet, the problem with both those recommendations is that there’s strong—and growing—evidence that statin use can lead to diabetes, and diabetes is one of the biggest risk factors for heart disease. So, taking statins as prevention can lead to more heart issues than they prevent.
Statin Drug Use Ups the Chances of Developing Diabetes—Significantly
As you may remember, a few years back I reported on a multi-year study published in the Archive of Internal Medicine that showed a strong link between statin use and diabetes. That study followed nearly 154,000 women in the Women’s Health Initiative and found that post-menopausal women taking certain types of statins had a 48% greater risk of developing type 2 diabetes.
Now, a new study just released in 2015 in the journal Diabetologia has found a similar relationship for men. Researchers at the Institute of Clinical Medicine at the University of Eastern Finland and Kuopio University Hospital in Finland looked at statin drug use among 8,749 Caucasian men, ages 45-73. All were participating in the Finland-based Metabolic Syndrome in Men (METSIM) study.
At the beginning of the study, none of the men had diabetes. But in the 5.9 year follow-up period 625 of the participants developed type 2 diabetes—and those who took statin drugs were at highest risk. This was true even after the researchers adjusted their findings for age, waist size, and body mass index (BMI).
High Dose Statins Were More Likely to Lead to Diabetes Than Low Doses
In this newest study published in journal Diabetologia, the researchers looked at two types of statins: simvastatin and atorvastatin. Those taking high-dose simvastatin had a 44% higher risk of developing type 2 diabetes, versus 28% for those taking lower doses. Plus, those taking high-dose atorvastatin had a 37% increased risk of getting diabetes. What the researchers also found is that those taking statin drugs had a 24% reduction in insulin sensitivity, and a 12% reduction in the amount of insulin excreted—all of which lead to diabetes.
This isn’t the first time that high-dose statins were shown to increase diabetes risk. A few years back, a Journal of American Medical Association (JAMA) study compared the diabetes risk for those taking a daily high-dose statin of 80 mg, to those taking lower doses—and found that the high-dose statin group had a 12% increased risk.
Plus, the famous JUPITER study, which was initiated to prove the benefits of statin drugs on patients with low-to-normal LDL cholesterol, was halted because patients were developing diabetes at increased rates.
This issue of high-dose statins has even touched much closer to home—in my own practice. One of my employee’s fathers had bypass surgery and I recently went over his lab work. He’s on a high-dose statin and both his blood sugar and A1C was elevated—and he’s never had diabetes before. I told my employee her father should cut that high-dose statin in half.
Why Does Statin Use Lead to Diabetes?
The exact mechanism of why statins can lead to diabetes hasn't been confirmed, but there are several things we do know. Research has found that statins affect the HMG-coenzyme A reductase pathway, the same pathway that can lead to weight gain, insulin resistance, and diabetes. Those with a genetic weakness are especially vulnerable.
Statins also impede important biochemical pathways as they block cholesterol, such as production of Coenzyme Q10 (CoQ10) as well as agents that impact insulin growth factor IGF. We also know that abnormally low IGF-1 levels are associated with the premature development of type 2 diabetes. Plus, statins lead to insulin resistance and weight gain.
The Bottom Line for Statins and Diabetes
The same advice I’ve been giving for years still holds. The only group of people who should be on statin drugs is middle-aged males with coronary artery disease. This group has the most to gain from these medications, so the medications far outweigh the risks. Plus, low doses are better than high doses.
But statin drugs are not for postmenopausal women since we lack convincing evidence that statin therapy confers any protective benefits at all for postmenopausal women. Plus, for both men and women statins shouldn’t be used as a broad-brush preventive measure since they have numerous unwanted side effects, including memory loss, diabetes, cataracts, and more.
Statins are very complex drugs that have what are called “pleotropic effects”—some good and some bad. And we need to educate doctors about using caution when prescribing these drugs. In fact, I just wrote a paper about this topic that’s currently being peer reviewed for inclusion in a major medical journal. Getting the word out is critical.
I also want to reiterate something I’ve said before, that the benefit of statin drugs isn’t the cholesterol-lowering effect. Rather, it’s the fact that statin drugs thin the blood and reduce inflammation, which is the real way to combat coronary artery disease.
Finally, I want to remind you that if you’re on a statin drug, you MUST take Coenzyme Q10 (CoQ10) because statins deplete the body of this important nutrient. At a minimum, you want to take 200 mg of highly absorbable CoQ10 in divided doses with your statins. That’s just smart medicine.
Now it’s your turn: Do you have any questions about statins and diabetes?
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