Statins: Good for the Heart, Maybe Not So Good for Diabetes
Statins are proven to lower cholesterol, but they may also come with a downside for patients with diabetes: A new study finds they may make the blood sugar disease worse.
Researchers found that among those taking statins, 56% saw their diabetes progress, compared with 48% of those not taking statins. And the higher the dose of the statin, the faster the progression of the diabetes.
"This study should be a start to more research examining the balance of benefits and harms of statins in patients with diabetes," said senior researcher Dr. Ishak Mansi. He is a professor in the Departments of Medicine and Data and Population Science at the University of Texas Southwestern in Dallas.
"We know well about the benefits of statins, but the harms are much less investigated," Mansi said. "Specifically, what is the population that may benefit less from the use of statins for primary prevention or be harmed? Answering these questions impact hundreds of millions of patients and cannot be postponed."
He cautioned that based solely on this one finding, no patient should stop taking their statins and that association does not prove causation.
For the study, Mansi and his colleagues collected data on more than 83,000 diabetic patients who used statins and more than 83,000 who didn't.
Those who were taking statins were more likely to see their diabetes progress and need to start using insulin and other types of drugs to lower high blood sugar levels sooner than those who weren't taking statins.
"The study may alert clinicians that they may need to pay close attention and expect to adjust anti-diabetes medications when they initiate statins," Mansi said.
Dr. Joel Zonszein, an emeritus professor of medicine at the Albert Einstein College of Medicine in New York City, said that blood sugar is not the only key to managing type 2 diabetes.
"Management of type 2 diabetes is not centered on lowering blood sugars," explained Zonszein, who wasn't part of the study. "In addition to lifestyle changes, medications are often necessary to prevent or attenuate complications. Statins are highly effective in lowering cholesterol and protecting against heart attacks and strokes."
Statins do not cause diabetes and the modestly increased rate in precipitating new-onset diabetes is well-known, though the exact mechanism remains unknown, he said.
"The benefits of statins in patients with type 2 diabetes are far greater than the potential side effects," Zonszein added.
Millions of people have been treated with statins, and its widespread application has been a major public health advance, he noted.
Treatment of obesity, hypertension and high cholesterol is as important as improving glycemic control, Zonszein added, and statins are one of the best medications for these in patients with type 2 diabetes.
"When prescribing any medication, a careful balance between benefits and side effects is discussed between the health care provider and the patient," Zonszein said. "In the case of statins, the benefits, particularly in patients with type 2 diabetes, are by far better than potential side effects."
The report was published online Oct. 4 in the journal JAMA Internal Medicine.
For more on type 2 diabetes, see the American Diabetes Association.
SOURCES: Ishak Mansi, MD, professor, Departments of Medicine and Data and Population Science, University of Texas Southwestern, Dallas; Joel Zonszein, MD, emeritus professor, medicine, Albert Einstein College of Medicine, New York City; JAMA Internal Medicine, online, Oct. 4, 2021
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