recent study suggests that the long-term use of statins, the most popular drugs
used to lower blood cholesterol levels, could increase the risk of diabetes in
certain susceptible individuals by around 30%.
- Statins appear to
increase the risk of diabetes in susceptible individuals by around 30%
- The risk could
possibly be due to reduced insulin secretion
- However, the
benefits of statins in cardiovascular disease is very well established and
they should not be differed due to the possible risk of diabetes.
The study was published
in BMJ Open Diabetes Research & Care
scientists obtained their data from the Diabetes Prevention Program Outcomes
This was a follow-up study of the Diabetes Prevention
Program (DPP) trial conducted on 3234 patients, which checked whether lifestyle
interventions, the anti-diabetes drug metformin
or placebo could reduce the development of
diabetes in overweight and obese individuals at a high risk for diabetes. These
individuals had fasting plasma glucose levels of between 95 and 125 mg/dL and
impaired glucose tolerance (IGT).
‘Statins appear to increase the risk of diabetes in susceptible individuals; however, their use should not be deferred in individuals who would experience their cardiovascular benefits’
During the DPPOS study,
the presence of diabetes was assessed through a yearly glucose tolerance test
and a half-yearly fasting blood glucose measurement. The cholesterol levels,
patients' statin use, waist circumference, body weight and blood pressure were
After a duration of 10
years, the scientists found that:
- The use of
statins before the onset of diabetes was similar in the lifestyle
intervention, metformin and placebo groups. Simvastatin
was the most commonly used
statin followed by atorvastatin, lovastatin and lastly, pravastatin.
- The use of statins increased the risk of diabetes in
susceptible individuals by around 30%.
The increased risk for diabetes with long term statin use was
statistically significant in the lifestyle intervention group.
- The risk for diabetes was not affected by the potency
of the particular statin.
- The diabetes was
not associated with a reduced insulin sensitivity since the fasting
insulin levels were not altered. In
the lifestyle intervention group, statistically significant reduction in
insulin secretion was noted, which could explain the development of diabetes.
Since these individuals had a higher genetic risk for diabetes, the
statins could have accelerated the development of diabetes. However,
further investigation is needed to establish the mechanism by which
statins may be related to the development of diabetes.
The study thus
re-iterates the suggestion from other observational studies that statins could
increase the risk of diabetes. This does
not mean that the use of statins should be stopped or avoided in those who need
them; statins have a proven benefit in reducing heart attack, stroke and
cardiovascular death in such patients.
Patients at a high risk of diabetes
taking statins should however be monitored on a regular basis for the
development of diabetes.
Statins are drugs that are used to reduce
the levels of bad cholesterol, and thereby prevent its harmful effects on the
cardiovascular system. Statins inhibit an enzyme called HMG CoA reductase,
thereby preventing the formation of bad cholesterol. Other effects on systemic
inflammation, endothelial function (the endothelium is the inner layer of the
blood vessels) and oxidative stress may also add to the beneficial effects of
statins in cardiovascular disease.
- Crandall JP et al. Statin use and risk of developing diabetes: results from the Diabetes Prevention Program. Doi 10.1136/bmjdrc-2017-000438