Statins: The Diabetes dilemma

Continuing our trend of discussing the latest controversies of medical sciences, this one has the potential of overshadowing all the others.

Statins - Atorvastatin, Simvastatin, Rosuvastatin, to name a few, is a group of drugs which were primarily used to reduce the lipid levels. Over the course of time, many beneficial effects of this class of drugs were unearthed which has led to widespread and over the counter use of these tablets.

These beneficial/pleiotropic effects of statins include plaque stabilization, reduction of inflammation, reversal of endothelial dysfunction, and decreased thrombogenicity.

Numerous trials have shown a benefit for statin therapy both as primary patients who have never had heart disease and are taking statins to lower their risk (so-called primary prevention) and secondary prevention of cardiovascular disease (CVD) and mortality. Trials like the Collaborative Atorvastatin Diabetes Study (CARDS), proved beyond doubt that patients with type 2 diabetes and other risk factors for CVD should be treated with a statin, apparently disregarding their initial LDL cholesterol level.
Also, according to the New Canadian guidelines, all patients with Diabetes should start taking statins when they turn 40.

Diabetes Dilemma:

A number of large, clinical trials have now shown that use of statins can increase the risk of developing type-2 diabetes by about 9 percent.

Risk factors for Diabetes

This is fairly serious, especially if you are in the large group of patients who have not yet had a cardiovascular event, but just take statin drugs to lower your risks of heart disease.

Statins reduce the levels of Coenzyme Q10 which is needed for energy and other cellular functions. Also, they reduce the levels of a protein GLUT4 which leads to insulin resistance and onset of type 2 Diabetes mellitus. Supplementation of CoQ10 may possibly negate this effect.

Complications of Diabetes

In one study, diabetes mellitus was diagnosed in 27% more patients receiving a statin (rosuvastatin) compared with patients receiving placebo (an identical appearing pill that does not contain medication), but patients receiving the statin had a significant 54% lower risk of heart attack, 48% lower risk of stroke, and 20% lower risk of death.

Symptoms of Diabetes

There is a wealth of clinical data showing that patients with diabetes mellitus benefit greatly from statin therapy to prevent cardiac events. The current data do not support discontinuing statins if you have diabetes mellitus or if you are newly diagnosed with diabetes mellitus.


Conclusion:

What should people who are taking statins do? If these are prescribed for someone who has already had heart disease or a stroke, the benefit is overriding — no changes are suggested. However, physicians need to monitor the sugars of these patients. But in the vast majority of people who take statins — those who have never had any heart disease — there should be a careful review of whether the statin is necessary, in light of the risk of diabetes and the relatively small benefit that can be derived. Maybe a dose reduction or use of a less potent statin should be considered on an individual basis.