With any medication, there are benefits and risks that need to be considered. Medications are generally recommended to a patient when the potential benefit of the medication is felt to be greater than the potential risks.
While it is extremely important for both doctors and patients to be well informed of potential side effects of medications, the media unfortunately loves to hype up side effects, often making it seem like the risks of taking a medication must outweigh any potential benefits.
Statins, a group of cholesterol medications, have taken a particular beating in the media over the years. A colleague of mine approached me not too long ago saying that he was worried about his patients being afraid of taking their statin cholesterol medications because of fear of developing diabetes as a side effect, and asked me if I would publish a post on this topic.
An excellent review was published in The Lancet, which does a great job of addressing the question of benefit vs risk of statin therapy.
If 10,000 people are treated with statin therapy for 5 years: (with the example given of 40mg of atorvastatin (Lipitor) daily)
- if these 10,000 people had a past history of ‘blocked arteries’ (occlusive vascular disease) – eg prior heart attack or stroke: 1,000 would be saved from another heart attack or stroke
- if these 10,000 people had no history of vascular disease: 500 would be saved from a heart attack or stroke
- 50-100 will develop diabetes because of their statin
- 5-10 will have a bleeding type (hemorrhagic) stroke
- 5 will develop serious muscle complications
The risk of developing diabetes due to statin medications is higher with the more powerful statins (atorvastatin (Lipitor) and rosuvastatin (Crestor)), and with higher doses. However, it is precisely these particular statins at the higher doses that have the biggest benefit to prevent heart attacks and strokes in people who have a past history of vascular disease.
People with risk factors for developing diabetes (eg, prediabetes, obesity) are at higher risk of statins tipping them up into diabetes range blood sugars. However, even if a person develops diabetes due to their statin, the health benefit in preventing heart attacks and strokes is much greater than the adverse effect of diabetes on their health, provided the diabetes is well managed.
For people who already have diabetes, statins also have a powerful benefit in preventing heart attacks and strokes, which is felt to far outweigh any small increase in blood sugars that may occur (and can be managed with adjustment to diabetes medication).
As to how statins increase the risk of developing diabetes, another study in The Lancet suggests that it may be related to the mechanism of statins to inhibit an enzyme called HMG CoA reductase, and may be genetically mediated.
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