Recent studies of popular statins showed a significant increase in the risk for diabetes associated with statin therapy. More potent statins that include Zocor (simvastatin), Lipitor (atorvastatin) and Crestor (rosuvastatin), particularly at higher doses, are associated with a higher risk for diabetes.
A publication of The Women’s Health Initiative analysis of more than 153,000 women, ages 50-79 diagnosed more than 10,000 cases of diabetes during follow-up, were .
Eric Topol, M.D. in the March 4, 2012 NYTimes issue: “More than 20 million Americans take statins. That would equate to 100,000 new statin-induced diabetics. 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.”
In postmenopausal women this risk is much higher:
Data from the Women’s Health Initiative (WHI) of 153 840 postmenopausal women aged 50–79 years report a 48% increased risk of diabetes among the women taking the statins. This increased risk of diabetes was observed in white, Hispanic, and Asian women (49%, 57%, and 78%, respectively), but not in African Americans. Contrary to expectations, women with a lower BMI (<25.0 kg/m2) appeared to be at a higher risk of diabetes compared with obese women.
Doctors often prescribe statins for patients with high cholesterol to reduce their risk of a heart attack or stroke. Most people taking statins will take them for the rest of their lives, which can make statin side effects difficult to manage.
In a patient with normal cholesterol levels and no risk factors such as diabetes, high blood pressure or cardiovascular disease, it is hard to justify the potential side effects and costs. It has been estimated that treating 1,000 people with statins for one year would lower the number of deaths from nine to eight.
Therefore, the routine use of a statin in patients with normal cholesterol levels is somewhat controversial 1). Current guidelines for the prevention of heart disease and stroke are limited to patients who have a 20% or greater 10-year risk of developing CVD 2), Preventive measures for heart disease rather focus on behavior modification such as diet , exercise and cessation of smoking. (You can calculate your risk here).
The preventive use of statins should also include clinical assessment of older patients with diabetes or high-risk ethnic groups. The decision to begin statin therapy should be made after a discussion with your doctor about the risks and benefits of statin treatment, taking your overall health into account.
What to do if you are using a statin medication?
We have discussed the potential risks and benefits of statin use before and recommend the following:
- If you have heart disease or have had a stroke, take your statin.
- If you have never had any heart disease, you and your doctors should review whether the statin is really necessary, in light of the risk of diabetes, the relatively small benefit and the potential serious side effects, especially with the newer and more potent drugs.
References
1. Annie L. Culver et al: Statin use and risk of diabetes mellitus in postmenopausal women in the Women’s Health Initiative. Arch Intern Med, Jan 2012; 172: 144 – 152.
2. The use of a statin may increase your risk of diabetes
3. Should everybody use a statin to prevent heart disease and stroke?
4. Statin benefits questioned in low-risk patients
5.Statin usage in low risk patients