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VOLUME 17 NUMBER 1 • JULY 2020
DRUG TRENDS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Statins linked to doubled risk of type 2 diabetes
A
study of thousands of patients’ health
records found that those who were
prescribed cholesterol-lowering statins had
at least double the risk of developing type
2 diabetes. The detailed analysis of health
records and other data from patients in
a private insurance plan in the Midwest
provides a real-world picture of how efforts
to reduce heart disease may be contributing
to another major medical concern, said
Victoria Zigmont, who led the study as a
graduate student in public health at The
Ohio State University.
Statins are a class of drugs that can lower
cholesterol and blood pressure, reducing
the risk of heart attack and stroke. More
than a quarter of middle-aged adults use
a cholesterol-lowering drug, according to
recent federal estimates.
Researchers found that statin users had
more than double the risk of a diabetes
diagnosis compared to those who didn’t
take the drugs. Those who took the
cholesterol-lowering drugs for more than
two years had more than three times the
risk of diabetes. ‘The fact that increased
duration of statin use was associated with
an increased risk of diabetes – something
we call a dose-dependent relationship –
makes us think that this is likely a causal
relationship,’ Zigmont said.
‘That said, statins are very effective
in preventing heart attacks and strokes. I
would never recommend that people stop
taking the statin they’ve been prescribed
based on this study, but it should open
up further discussions about diabetes
prevention and patient and provider
awareness of the issue.’
Researchers also found that statin users
were 6.5% more likely to have a troublingly
high HbA
1c
value – a routine blood test for
diabetes that estimates average blood sugar
level over several months.
The study included 4 683 men and
women who did not have diabetes, were
candidates for statins based on heart disease
risk and had not yet taken the drugs at the
start of the study. About 16% of the group
(755 patients) were eventually prescribed
statins during the study period, which ran
from 2011 until 2014. Participants’ average
age was 46 years.
Randall Harris, a study co-author and
professor of medicine and public health at
Ohio State, said that the results suggest
that individuals taking statins should be
followed closely to detect changes in
glucose metabolism and should receive
special guidance on diet and exercise for
prevention.
Although statins have clear benefits in
appropriate patients, scientists and clinicians
should further explore the impact of statins
on human metabolism, in particular the
interaction between lipid and carbohydrate
metabolism, said co-author Steven Clinton,
a professor of medicine and member of
Ohio State’s Comprehensive Cancer Centre.
‘In addition, researchers conducting
large prospective cohort studies should be
considering how statins impact on human
health overall. They should consider both
risks and benefits, not just the disease that is
being treated by the specific drug,’ Clinton
said.
The study was done retrospectively,
meaning that the researchers looked back
at existing records from a group of patients
to determine if there were any possible
connections between statin prescriptions
and diabetes. Previous research has
suggested a connection, but this study
design allowed for a glimpse at what is
happening naturally in the clinical setting,
rather than what happens in a prospective
trial that randomly assigns some people to
statins and some people to placebo, said
Zigmont, who is now an assistant professor
at Southern Connecticut State University.
The study was enriched by the availability
of a variety of details on the study
population, including data from biometric
screenings and a health survey that asked
about education, health behaviours and
ethnicity, Zigmont said. She also had access
to medical and pharmacy claims data.
‘Zigmont was careful to take a wide
variety of confounding factors into account
in an effort to better determine if the statins
were likely to have caused the diabetes,’
she said. ‘Those included gender, age,
ethnicity, education level, cholesterol and
triglyceride readings, body mass index, waist
circumference and the number of visits to
the doctor. Programmes that help patients
improve their fitness and diets could be
considered and discussed when doctors are
prescribing statins, so that patients can be
proactive about diabetes prevention,’ she
said.
‘It would also be helpful for future
research to better determine which statins
and which doses might lead to the greatest
risk,’ Zigmont said. Her study didn’t allow for
an analysis based on different types of statins.
‘Limitations of the research include the
fact that the majority of statin users were
white, and that the research team had
no way of knowing how closely patients
adhered to their doctors’ prescriptions.
There also was no way of determining
who was at elevated risk of diabetes at the
study’s onset,’ Zigmont says.
Source: Medical Brief 2020
Drug Trends in Diabetes