Why Statins Are Recommended in Diabetes

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A few years ago, researchers began noticing a relationship between the use of statin drugs and an increased risk of developing type 2 diabetes. This association, which was first recognized in the famous Jupiter study, was initially written off as a likely aberrancy. But a subsequent meta analysis of several large clinical trials confirmed the relationship, and further, showed that the larger the dose of the statin, the higher the risk of type 2 diabetes.

Overall, the risk of developing type 2 diabetes appears to be about 12% higher among patients taking statins.

As a result of these findings, in 2012 the FDA required changes to the labeling of statin drugs, warning that these drugs may increase the risk of diabetes.

How Do Statins Increase Diabetes Risk?

Once the association between statins and type 2 diabetes was widely accepted, researchers began looking for the cause. Do statins somehow inherently increase the risk of diabetes? Or, does the diabetes risk stem from some peripheral cause? (For instance, it has been speculated that perhaps some patients taking statins may be more likely to abandon a heart-healthy diet, because they believe their statins will protect them.)

In September, 2014, researchers from London and Glasgow reported that they had discovered the likely mechanism by which statins can increase type 2 diabetes.

In a sophisticated analysis employing genetic typing and data from several randomized statin trials, they concluded that the increased incidence of diabetes with statins is, at least partially, due to the fundamental mechanism of action of statins. In particular, taking a drug that inhibits the enzyme HMG-CoA (which is how statin drugs work), will inherently increase the risk of developing type 2 diabetes in genetically susceptible patients.

This means that an increased risk of diabetes is inherent with statin drugs. Since this risk is caused by the fundamental mechanism of action of the statins, it also means it is unlikely that drug companies will be able to “engineer” their way around this problem by developing more advanced statin drugs.

What This Means For People Taking Statins

Experts - including the authors of this latest study - are quick to point out that statins are so useful in reducing overall cardiovascular risk that a small increase in the risk of developing type 2 diabetes should not deter doctors from prescribing these drugs - or patients from taking them.

And certainly, if you are in a very high-risk category - for instance, if you already have coronary artery disease or have had a stroke - the use of statins significantly and substantially reduces your risk of having a serious cardiovascular event, despite an increased risk of type 2 diabetes.

The issue may not be as clear-cut, however, if you are in a more moderate cardiovascular risk category.

And after the latest cholesterol guidelines were published in 2013, statins have been recommended for many more people whose risk is considered moderate.

If your cardiac risk is moderate, the relative benefit of taking a statin is not as large - and the potential risk of diabetes may be more important. If you find yourself in this group, you should have a pointed discussion with your doctor about the best way to reduce your cardiovascular risk. It may very well be - as the experts insist - that even if you are in this category the benefits of statins will far outweigh your risks. However, you and your doctor might also consider whether an aggressive program of lifestyle changes might move you into a lower risk category - where even the guidelines will agree that statins are not necessary.


Swerdlow DI, Preiss D, Kuchenbaecker KB, et al. HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: Evidence from genetic analysis and randomized trials. Lancet 2014; DOI: 10.1016/S0140–6736(14)61183–1.

Frayling TM. Statins and type 2 diabetes: Genetic studies on target. Lancet 2014; DOI: 10.1016/S0140–6736(14)61639–1.  Editorial

Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; DOI:10.1016/S0140–6736(09)61965–6.

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