Are Statins Worth the Diabetes Risk?

Medscape Diabetes & Endocrinology > Viewpoints

Gregory A. Nichols, PhD

Apr 08, 2013

Viewpoint

Recent studies indicating an increased incidence of diabetes associated with statins have raised concerns on 2 fronts. First, some may worry that the hyperglycemic effect of statins may put individuals at risk of developing a serious chronic disease. Indeed, a meta-analysis of previous studies found a 9% increased risk for diabetes associated with statin use. Furthermore, there appears to be a dose response with greater risk for diabetes among patients who are treated intensively with statins compared with placebo or moderate statin doses. However, few would argue that statins provide substantial cardioprotection; therefore, a second concern is that the relatively low risk of developing diabetes might cause some patients to avoid statin therapy despite being at high risk for cardiovascular events.

The current study suggests that the risk of developing diabetes is limited to patients who are already at high risk. The minor increase in blood glucose with statins may be enough to push at-risk patients across the diagnostic threshold. After all, the single strongest predictor of diabetes is hyperglycemia; the higher the glucose, the greater the risk.

 We can now be reasonably comfortable that statins increase diabetes only among people who are probably going to develop it anyway. In addition, although the present study included other important risk factors for diabetes, such as HDL cholesterol and blood pressure, the authors were unclear about whether they were controlled for in the multivariable analyses. If not, it is possible that the residual risk associated with statin therapy would be lower or nonexistent if more extensive models were constructed. In any event, even if diabetes does develop at a somewhat higher rate among high-risk statin users, there is nothing magical about the diagnosis of diabetes. Regardless of whether the patient is at high risk for diabetes or has been diagnosed, one of the primary treatment goals is to reduce the risk for complications, especially cardiovascular disease, which is best achieved with statin therapy to reduce LDL cholesterol.