(RxWiki News) Deciding how to treat a condition like high cholesterol can be tough, especially when some treatment options have been tied to an increased risk of other health problems.
The authors of a new review took a look at one such instance — a common type of cholesterol medication, statins, which have been tied to an increased risk of developing diabetes.
After reviewing data from previous studies, these authors concluded that the benefits to cardiovascular health provided by statins outweighed the small, but present, increased risk of diabetes.
"Ask your pharmacist any questions about your prescriptions."
Led by David S. H. Bell, MB (Bachelor of Medicine), of Southside Endocrinology and the University of Alabama at Birmingham, this review took a look at a wide variety of studies to explore a potential link between diabetes and statin medications.
Statins were created to help lower high cholesterol levels — a risk factor for heart disease and heart attacks. Examples of statin medications include atorvastatin (brand name Lipitor), simvastatin (Zocor) and rosuvastatin (Crestor), among others.
Bell and colleagues cited a number of studies and reviews that found an increased risk for diabetes with use of the medications, though results varied from study to study and from statin to statin.
For example, a 2001 study called the West of Scotland Coronary Prevention Study (WOSCOPS) actually hinted that pravastatin (Pravachol) decreased diabetes risk by 30 percent. However, Bell and colleagues noted that the study participants were not a group at high risk for developing the condition.
In a later study, the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER), the medication was associated with a 32 percent increase in diabetes, especially in those who showed symptoms of insulin resistance.
In another study — the Justification for the Use of Statins in Primary Prevention: Intervention Trial Evaluating Rosuvastatin (JUPITER) — results showed a 44 percent drop in cardiac events, but alongside a 26 percent increase in new cases of diabetes.
According to the review's authors, these and other findings led the US Food and Drug Administration (FDA) to update the labeling of statin medications in February 2012 to warn against a possible increased diabetes risk.
However, Bell and colleagues noted that the story did not stop there. Discussion and questions continued, with some hypothesizing that perhaps higher doses of statin medications were behind the diabetes issue.
Bell and team cited an analysis of studies involving cardiac patients, called the Effective Cardiac Treatment (EFFECT) study, which looked at five trials with over 1,000 subjects receiving high-dose statin therapy. In the EFFECT analysis, 8.8 percent of patients taking high doses developed diabetes, compared to 8.0 percent of those who took low doses.
According to Bell and colleagues, while this 0.8 percent difference was significant, it was outweighed by the 2.6 percent reduction in cardiac events also seen in the high-dose patients.
The review authors also highlighted the possibility that participants in these statin studies were already predisposed to diabetes, perhaps due to other health issues and risk factors, like insulin resistance, obesity and older age.
They noted that in the JUPITER trial, those who had one or more of these diabetes risk factors saw a 28 percent increase in diabetes cases, while those without risk factors had no increased risk for developing the condition.
After analyzing all this data, Bell and colleagues acknowledged an increased diabetes risk, especially among those who already have risk factors for diabetes. However, they concluded that the benefits of statin medication outweighed this risk.
"Overall, the small risk of developing type 2 diabetes with statin therapy is far outweighed by the potential of statins to decrease cardiac events," Bell and colleagues wrote.
In an interview with dailyRx News, Sarah Samaan, MD, cardiologist at the Baylor Heart Hospital in Plano, Texas, agreed that the cardiovascular benefits of statins outweigh the diabetes risk.
"When prescribed appropriately, for people with cardiovascular disease or those at high risk of developing it, statins prevent heart attacks and strokes, and save lives," explained Dr. Samaan. "While there is a small chance that someone on a statin may develop diabetes as a result of the treatment, those people who become diabetic tend to be those at higher risk for the disease in the first place."
Dr. Samaan also highlighted the importance of lifestyle choices in keeping hearts healthy.
"I think it's important to understand that preventing heart disease does not begin and end with a pill," said Dr. Samaan. "It's critical that individuals take responsibility for their own health. By exercising regularly, choosing a smart diet, not smoking and keeping weight in a safe range, heart disease can often be prevented."
"For those with heart disease, these healthy lifestyle choices will often mean that a lower dose of statin is required. And of course since it is those people at higher risk for diabetes who are more likely to become diabetic on a statin, making these healthy choices will also lessen the risk of this side effect," Dr. Samaan told dailyRx News.
Bell and colleagues stressed that there has never been a full study designed to primarily explore a connection between statins and diabetes risk. Further research is needed to more fully understand the relationship between the two.
This review was published online January 20 in the journal Diabetes, Obesity and Metabolism. No conflicts of interest were reported.
