Adapted from BMJ 20 May 2023 Risk of diabetes with statins by Ishak A Mansi et al.
Statin medications lower cholesterol and have an anti-inflammatory effect that shows benefits in cardiovascular morbidity and mortality, particularly for secondary prevention, when a heart attack or stroke has already occurred. Yet studies have shown a 46% relative risk increase for diabetes, possibly due to a direct toxic effect on mitochondrial pancreatic beta cells.
Based on some randomised controlled trials it is thought that for every 100 to 250 people who take statins for 2 to 5 years, on additional person will develop diabetes due to taking the statin. Studies also indicate that the risk is higher if the statin dose is higher. The risk is greatest in the first four months of treatment. People who already have diabetes may find that their blood sugar control worsens. If you already have impaired fasting blood glucose, metabolic syndrome, fatty liver, are over 65 in age, or have obesity, this can tip you into a diabetes diagnosis.
It is still thought that despite these problems, statin use is still more beneficial overall compared to not prescribing them, particularly for if you have already had a stroke or heart attack.
What can you do?
Exercise and adopt a low glycaemic diet. This will also reduce your cardiovascular risk independent of its beneficial effect on improving insulin resistance and lowering blood sugars.
What can your doctor do?
Consider prescribing Metformin or a glitazone if you are starting a statin and already have pre-diabetes.
Check blood glucose levels before starting a statin and at three months afterwards and then yearly.
Check Thyroid function as low thyroid levels can raise cholesterol levels.
Think twice about high intensity statins. Are they really necessary?
Change medications that already raise the risk of diabetes such as thiazide diuretics and beta blockers, particularly if there are no strong indications for these particular drugs.
Minimise drug interactions from other medications that raise the effects of statins in the body. These include: amiodarone, clarithromycin, diltiazem, grapefruit juice, itraconazole, ketoconazole, protease inhibitors as these increase the potency of simvastatin, atorvastatin and lovastatin.
Cyclosporin affects transport proteins and also raises the potency of statins.
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