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VOLUME 17 NUMBER 2 • NOVEMBER 2020
Diabetes News
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 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 claims
data 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, educational 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
2019
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