A study out of Finland, released online only at this time, evaluated the incidence of newly-diagnosed diabetes among men taking statin drugs for elevated cholesterol, as compared to those not taking statins. The results may have a major impact on the clinical approach to prescribing statins, especially among patients whose indications for such treatment are unclear.
The authors, led by Drs. Hanna Cederberg and Markku Laakso of the University of Eastern Finland, followed about 8,800 men, aged 45-73 years, for about 6 years, as part of the Metabolic Syndrome in Men (METSIM) study cohort. All the men were non-diabetic at the outset. Statins were being used by 2,142 men, and over the course of the study, 625 men developed diabetes. After controlling for numerous factors known to contribute to (or possibly contribute to) the development of diabetes, it was determined that those on statins were 46 percent more likely to have developed diabetes than those not on this class of drugs. (Most of the statin users were on atorvastatin or simvastatin, and there was a dose-response relationship between the amount of those 2 drugs and the risk of diabetes; other statins were not taken by enough subjects to warrant statistical evaluation).
To further investigate the possible reasons why such an effect should occur, the authors also evaluated the group s insulin sensitivity and secretion rates. And consistent with the overall findings, both insulin tests were reduced (by 24 percent and 12 percent, respectively).
ACSH s Dr. Gil Ross had these thoughts: Based on several studies over the past five years, I d come around to the belief that there was indeed an increased risk of diabetes consequent to statins in the 10-15 percent range. This large and carefully done study augments that risk substantially, making consideration of the risk-benefit equation of prescribing statins an entirely new algorithm. For one thing, the rapid recourse to statins on a just in case basis for primary prevention of CVD (ie, in patients who have not had a CVD episode yet), which has not been proven to actually improve outcomes significantly, should be reconsidered. And patients on statins, even for good reasons, should try to lose weight and have their blood sugars and glycohemoglobins checked regularly. But it must be kept in focus: one of the major adverse effects of diabetes is on heart disease (CVD), and patients taking statins are generally being treated to reduce exactly that. No one should stop or even reduce their statin dose without discussing such a move with their doctor.