Can Cholesterol Drugs Cause Diabetes?

For every prescription drug that is developed and offers benefits to patients, there are those that also pose significant risks. Physicians must always weigh the benefits to risks in order to make informed decisions as to whether a particular medication should be used for treatment.

Recent findings suggest statins, a class of prescription drug used to treat high cholesterol levels, increase the risk of developing diabetes. The data on the effectiveness of statins in preventing heart attacks and stroke is unclear.  They do seem to provide some benefit in patients who have already experienced a previous cardiovascular episode and are very likely to experience another one. But there is cause for concern over the widespread use of statins in patients with a lower risk of cardiovascular disease and the potential for these patients to eventually develop another disease, diabetes.

“I've said for years that statins are a blessing and a curse, because they do incredibly good things, but they can do bad things. The problem with a statin is this: You don't want to choose a statin to lower a cholesterol number. To me, that's bad medicine.” – Dr. Stephen Sinatra

What Do Statins Do Exactly?

Elevated blood cholesterol levels, specifically LDL (what some call “bad” cholesterol), have been associated with an increased risk of heart attacks and stroke. By testing LDL levels in patients, particularly small, dense LDL and Lp(a), a fairly accurate prediction can be made of future cardiac events. [1] As more research has been gathered on the role of LDL levels and heart disease, national guidelines have called for optimal LDL cholesterol levels to be lowered.

Enter statins.

Statins have the ability to block a critical step in the formation of LDL cholesterol within the liver, hence, the overall level of LDL in the blood drops. Because of this, statins are currently the most commonly prescribed class of drugs used to treat high cholesterol.

Until very recently, statins were thought to be safe and well tolerated by patients, though some studies reported side effects such as muscle weakness, temporary memory loss, and cognitive impairment. Though there is always the potential for more severe risks like liver failure, those cases are rare.

“About 10% of statin users get aches and pains. The higher your dose, the more likely you are to experience aches and pains.” – William W. O'Neill, MD.

The Statin Diabetes Connection

Findings from recent trials have shown that statins do have the ability to raise blood glucose levels and more patients on statin therapy have been diagnosed with diabetes compared to those not on statins. [2]

Though the risk of developing diabetes has been seen with statin treatment, it does not necessarily mean that every patient on a statin will develop the disease. However, the findings do clearly indicate that new-onset diabetes is more common in patients who have received statin treatment.

Statins Effect on Glucose

Many studies have found that statins can raise blood sugar, although the effect may be relatively small. In patients without diabetes, fasting sugars have been found to increase for patients using statins compared with those not using statins. This data is based on roughly 345,000 patients. [3] Patients with diabetes saw an increase in hemoglobin A1c by ≈0.3%. [4] 

Statins VS Other Risk Factors

When we view recent findings, we have to look for that risk/benefit ratio. For instance, data from 13 individual studies found that treating 255 patients with statins over the course of 4 years led to one extra case of diabetes. [5] So, though there is a definite connection between statin use and the development of diabetes, we also have to take into consideration that for some patients, treatment with statins may be beneficial.

This is why it’s critical to look at each patient as an individual and treat factors that contribute to the onset of diabetes. The same studies mentioned saw typical diabetes predictors in numerous test subjects, namely increased weight and unhealthy lifestyle choices resulting in higher blood sugar levels. Whether these patients are treated with statins or not, they are likely candidates for developing diabetes because of these risk factors.

What Does all of This Mean?

The answer to this question will be different depending on who you ask. Some in the medical community are advocates of pharmaceutical drugs and others prefer to treat patients with less invasive, more natural treatments. I happen to fall into this second camp.

At the end of the day, I’m not as concerned as to whether statins increase the risk of developing diabetes by a little or a lot. My concern is that diseases which can and should be treated with lifestyle changes are too often treated with medications that come with their own risks and nasty side effects.

I much prefer using a natural approach with my own patients. When it comes to lowering cholesterol levels, there are healthier options. Things like:

• Choosing healthy fats, and avoiding processed refined vegetable oils, and minimizing the saturated fats found in commercially-raised animal products.  Instead choose leaner cuts of organic, grass-fed or pastured animals and monounsaturated fats — found in avocado and olive oil.
• Avoiding trans fats found in fried foods and junk food like cookies and potato chips. Also, read ingredient lists and avoid foods containing partially hydrogenated oils.
• Eating foods rich in omega-3 fatty acids such as salmon, mackerel and herring, walnuts, almonds and ground flaxseeds.
• Increasing soluble fiber by eating fruits and veggies, as well and nuts and seeds.
• Exercise. It doesn’t have to be complicated, just move your body more.
• Quitting smoking. If you’re still smoking cigarettes, find a way to stop.

As always, I recommend that you speak with your own doctor regarding medication adjustments.  They can help you assess your individual benefits and risks to see what’s right for you.

Resources

[1] D'Agostino R, Vasan R, Pencina M, Wolf P, Cobain M, Massaro J, Kannel W. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117:743–753 [aha journals]

[2] Ridker PM, Danielson E, Fonseca F, Genest J, Gotto A, Kastelein J, Koenig W, Libby P, Lorenzatti A, MacFadyen J, Nordestgaard B, Shepherd J, Willerson J, Glynn R. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–2207. [NIH]

[3] Sukhija R, Prayaga S, Maashdeh M, Bursac Z, Kakar P, Bansal D, Sachdeva R, Kesan S, Mehta J. Effect of statins on fasting plasma glucose in diabetic and nondiabetic patients. J Investig Med. 2009;57:495–499 [NIH]

[4] Simsek S, Schalkwijk C, Wolffenbuttel B. Effects of rosuvastatin and atorvastatin on glycemic control in type 2 diabetes: the Corall Study. Diabet Med. 2012;29:628– 631 [NIH]

[5] Sattar N, Preiss D, Murray H, Welsh P, Buckley B, de Craen A, Seshasai S, McMurray J, Freeman D, Jukema J, Macfarlane P, Packard C, Stott D, Westendorp R, Shepherd, Davis B, Pressel S, Marchioli R, Marfisi R, Maggioni A, Tavazzi L, Tognoni G, Kjekshus J, Pedersen T, Cook T, Gotto A, Clearfield M, Downs J, Nakamura H, Ohashi Y, Mizuno K, Ray K, Ford I. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375:735–742. [NIH]