Cholesterol-lowering Statins Could Possibly Increase Diabetes Risk in Susceptible Individuals

Highlights:

• 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.

A 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%. The study was published in BMJ Open Diabetes Research & Care. The scientists obtained their data from the Diabetes Prevention Program Outcomes Study (DPPOS). 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).

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 also monitored.

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.

About Statins

  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.

Reference:

1. Crandall JP et al. Statin use and risk of developing diabetes: results from the Diabetes Prevention Program. Doi 10.1136/bmjdrc-2017-000438

Source-Medindia