Special for Infobae of New York Times.
(Science Times) ; (ask well)
Q: Do statins increase the risk of type 2 diabetes?
If you’re among the millions of Americans who could benefit from taking cholesterol-lowering drugs but aren’t taking any of them, your concerns may stem, in part, from concerns about adverse effects, said Savitha Subramanian, an endocrinologist from the University of Washington School of Medicine in Seattle.
Statins, which help lower LDL (or “bad” cholesterol) levels in the blood, can cause side effects such as headaches, muscle pain, brain fog, and fatigue. But one of the effects that most worries many people is the increased risk of developing type 2 diabetes, which prevents the body from properly regulating the use of sugar (or glucose) as an energy source.
According to Subramanian, while type 2 diabetes is a real problem, that doesn’t mean you should automatically avoid taking statins, and here’s why.
What are statins and how do they work?
Statins have been used since the 1980s to treat and prevent heart disease by lowering blood cholesterol levels. Doctors recommend them for people who have had heart attacks or strokes and for those who are at risk for these problems because of high cholesterol levels.
Although there are other lipid-lowering drugs, most adults who require these medications take statins, which inhibit enzymes in the liver that produce cholesterol. This prevents the buildup of fatty deposits in the blood vessels that could clog them over time and reduces the inflammation that is present when the arteries are clogged. These actions together decrease the chances that the patient will develop cardiovascular disease.
What is the relationship with type 2 diabetes?
When considering their anti-inflammatory effects, scientists in the early 2000s thought that statins could, in fact, prevent diabetes. But in a 2008 trial published in The New England Journal of Medicine, researchers found that healthy older adults who were given 20 milligrams of rosuvastatin (Crestor) every day were more likely to develop diabetes after two years than those who received a placebo.
Before that study, “there was an idea that maybe statins lowered the risk of diabetes,” said Jill Crandall, an endocrinologist at the Albert Einstein College of Medicine in New York. “In the end, we saw something totally opposite.”
Many other analyzes have confirmed the link between statins and diabetes risk, but the causes remain an enigma. So far, animal studies and human clinical trials suggest that statins might make cells more resistant to insulin, a hormone that helps regulate blood glucose levels. When this happens, blood sugar levels can rise so high that the risk of developing type 2 diabetes is aggravated.
Subramanian noted that while all statins can have such an effect, it is most often seen at “moderate to very high doses,” such as 40 or 80 milligrams daily of atorvastatin (Lipitor), or 20 or 40 milligrams of rosuvastatin.
What does this imply for my risk of diabetes?
Not everyone who takes statins develops diabetes, explained Marilyn Tan, an endocrinologist at Stanford University School of Medicine in California. For example, of approximately 8,900 adults who took rosuvastatin in the 2008 trial, 270 developed diabetes; 216 of that number who took a placebo also developed the disease. A 2010 analysis of these studies estimated that statin therapy was associated with a nine percent increased risk of developing diabetes.
But this does not happen to all people. A younger, healthy person has a much lower risk of diabetes than someone older with other risk factors, Tan said.
The risk is also increased if the patient is prediabetic, a situation in which blood sugar levels are high. It’s possible that statins raise blood sugar levels enough to shift a patient from prediabetic to diabetic, Crandall explained.
“But in reality, the change in blood sugar levels is quite modest, which means there’s not a vastly increased risk of developing diabetes or diabetes-related complications,” Crandall added.
Even if you take statins, certain lifestyle factors, such as being active and eating a healthy diet, can lower your chances of getting diabetes, Tan said.
However, fear of developing diabetes or other adverse effects can make people reluctant to take statins, Subramanian said. If this worries you, talk to a health care professional who can help you find the right class of statins and dosage for you, he recommended. Although high-intensity statins may increase the risk of some people developing diabetes, they are essential drugs to prevent cardiovascular disease, and their benefits far outweigh the risks.
“Statins get a really bad rap, but the risk of developing diabetes doesn’t have to stop patients from starting them,” Subramanian said.