People's Pharmacy, June 12, 2014
Recent guidelines from the American Heart Association and the American College of Cardiology strongly recommend that everyone with diabetes be prescribed a statin-type cholesterol-lowering medicine. But a new study of nearly 140,000 patients in Canada, the United States and the United Kingdom suggests that statins significantly increase the risk of developing diabetes.
All of the people in the study had been hospitalized for a heart attack, stroke or other cardiovascular crisis, but none had diabetes at the start of the study. Patients were prescribed statins on discharge from the hospital. Some received high-potency statins such as Crestor or high-dose atorvastatin or simvastatin. Others were prescribed low-potency statins or lower doses of Lipitor or Zocor.
Within two years of discharge, roughly 3,600 participants had been diagnosed with diabetes. Those who were prescribed higher potency statins were 15 percent more likely to develop this metabolic disorder. This is not the first study suggesting a relationship between statin use and the onset of diabetes. The investigators of the new meta-analysis point out that since there is no evidence that high-potency statins are better than low-potency statins at preventing complications or death, prescribers might want to consider lower doses of statins in patients at risk for diabetes.
[BMJ, May 29, 2014]
You may be interested in this commentary on the study for an in-depth perspective from The People's Pharmacy. While we see statins as helpful for people like the participants in this study who have had a heart attack or a stroke, we would like doctors to prescribe the lowest dose that will do the job. American physicians sometimes feel that the most aggressive treatment is the most beneficial, and that can lead to problems when the intervention has deleterious side effects. You can read more about potential problems with statins here and here and also here. Increasing the risk of diabetes also raises the possibility of many complications, including further cardiovascular problems.
The biggest red flag we'd like to wave is the use of high-potency statins for otherwise healthy people whose primary "problem" is high cholesterol. We now know enough about the downsides from long-term use of these medications that it makes sense to use diet, exercise and other alternatives to lower cholesterol when that is feasible. You can learn lots more about how to do that in our book, Best Choices From The People's Pharmacy.