Statins and Diabetes Risk

If you take statins to lower your cholesterol, you may be putting yourself at a sharply increased risk for type 2 diabetes, says a new study. In fact, men on statins faced a 46 percent higher risk of diabetes than men who were not treated with statins.

While itís not the first time a link between the use of statins (drugs that lower cholesterol) and a heightened diabetes risk has been reported, this new study is especially compelling: the diabetes risk was evident even after the researchers adjusted for the study participantsí age, family history of diabetes, body mass index (BMI), physical activity levels, and other diabetes risk factors.

Previous studies that examined the link between statins and an increased risk of diabetes focused on selective populations, including individuals who were at a greater than average risk of heart disease. Additionally, some past research described participants who self-reported their diabetes based on their own fasting glucose measurements. Due to this, the actual number of diabetes cases may not have been entirely accurate.

For this new study, Prof. Markku Laakso of the Institute of Clinical Medicine at the University of Eastern Finland and Kuopio University hospital in Finland focused on nearly 9,000 non-diabetic Caucasian men between the ages of 45 and 73. The men were part of the Finland-based Metabolic Syndrome in Men (METSIM) study. During the nearly six-year follow-up period, 625 of the men were diagnosed with type 2 diabetes.

"Statin treatment increased the risk of type 2 diabetes by 46 percent," the researchers concluded in Diabetologia.

"The association of statin use with an increased risk of developing diabetes is most likely directly related to statins decreasing both insulin sensitivity and secretion," says John P. Higgins, MD, an associate professor of medicine at The University of Texas Medical School at Houston. Insulin secretion is the process by which the body responds to elevated blood sugar levels by releasing insulin into the bloodstream, he explains. And a decrease in insulin sensitivity indicates the development of insulin resistance, or the inability to use insulin efficiently.

The U.S. Food and Drug Administration (FDA) has also warned patients taking statins that they may have an increased risk of raised blood sugar levels and the development of type 2 diabetes. Still, the information isnít meant to deter people from taking these drugs.

"The value of statins in preventing heart disease has been clearly established," says Amy G. Egan, MD, MPH, deputy director for safety in the FDAís Division of Metabolism and Endocrinology Products (DMEP) in a news release. "Their benefit is indisputable, but they need to be taken with care and knowledge of their side effects."

Other Treatment Options for People With High Cholesterol

Statins arenít the only medications for those who need to lower their cholesterol, Higgins says. "Bile-acid-binding resins or sequestrants are an option," he says. "They block cholesterol absorption into your blood stream and are not as strong as other drugs, so they are often used by people with only moderately high levels of cholesterol. Cholesterol absorption inhibitors prevent the small intestine from properly absorbing the cholesterol you consume from your diet."

In addition, he notes, niacin is a good option for individuals who need to lower their cholesterol and who donít respond well to other medications, since its side effects are mild.

What Statin Patients Should Know

If you are on statins, your doctor should monitor your blood sugar levels once or twice a year, just as a precaution, Higgins says.

Want to find other ways to keep your cholesterol and triglycerides (a type of fat in the blood) in check? "This can be done with a nutritionally balanced diet low in carbohydrates and high in healthy fats and lean protein," says Maria E. Pena, MD, endocrinologist and director of Weight Management of Medicine-Endocrinology/Metabolism at North Shore LIJ in New York City and Syosset, NY. She suggests the following cholesterol-lowering tips:

  1. Enjoy high fiber foods such as steel-cut oatmeal or oat bran.
  2. Eat foods rich in omega-3 fatty acids like fatty fish (salmon is popular) or flaxseeds.
  3. Use olive oil in place of butter.
  4. For a snack, enjoy a handful of nuts.
  5. Avoid foods that contain saturated fats and trans fats like certain meats, high-fat dairy products, and processed foods.
  6. "Most importantly, work on incorporating several minutes a day of physical activity--enough that you increase your heart rate," Pena says.

Stacey Rosen, MD, reviewed this article.

Sources

John Higgins, MD. Email interview April 28, 2015.

Maria Pena, MD. Email interview May 1, 2015.

Cederberg, Henna et al. "Increased Risk of Diabetes With Statin Treatment Is Associated With Impaired Insulin Sensitivity and Insulin Secretion: A 6 year Follow-up Study of the METSIM Cohort." Diabetologia 85, 5 (2015): 1109-1117.

Whiteman, Honor. "Study Finds Increased Risk of Type 2 Diabetes With Statin Use." Medical News Today. Last updated 20 April 2015.

"FDA Expands Advice on Statin Risks." U.S. Food and Drug Administration. Page last updated January 20, 2015.