Statins are often prescribed to manage cholesterol and treat heart disease. But research suggests that statins may pose risks related to type 2 diabetes. Available by prescription only, statins work by lowering the amount of cholesterol your liver produces. They help reduce low-density lipoprotein (LDL) cholesterol , or bad cholesterol, and raise high-density lipoprotein (HDL) cholesterol , or good cholesterol. Statins also decrease inflammation in the artery walls, lower the chance of blood clots forming, and reduce plaque buildup on artery walls. For these reasons, statins reduce the risk of heart disease , the leading cause of death for people in the United States. That’s especially important for people with type 2 diabetes, who are twice as likely to have heart disease or a stroke than people without diabetes.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294590e931-0006-4a3e-8b2b-38d453f8f6de But there’s evidence that taking statins increases type 2 diabetes risks for some people. Because type 2 diabetes is a risk factor for heart disease, people with high cholesterol may want to talk to their doctor about the benefits of taking statins versus the medication’s risks.
The Link Between Statins and Type 2 Diabetes Type 2 Diabetes Link Research suggests that statins may affect how the pancreas produces and releases insulin and how the body uses insulin. Insulin resistance can cause type 2 diabetes. One retrospective study found 56 percent of participants on statins experienced diabetes progression, including dangerous spikes in blood sugar or the need for new medications to manage blood sugar, compared with 48 percent of people who didn’t use statins. Participants on more intensive statin therapy, designed to reduce cholesterol levels more aggressively, had an 83 percent greater likelihood of diabetes progression.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b45435c6-7bea-4299-a98e-b0b17166180c Statin treatment, especially in higher doses, can increase insulin resistance and insulin secretion, according to other research.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c2542496-2078-484b-aaef-0cd0045fbfb6 “Why this happens isn’t fully understood,” says Stephanie J. Kim, MD, MPH , an endocrinologist at UW Medicine in Seattle. Insulin helps move glucose from your blood cells so your body can use it for energy. When the body doesn’t respond to insulin properly, glucose can build up in the blood. Elevated blood-glucose levels, called hyperglycemia , can occur if the pancreas can’t make enough insulin to compensate for the insulin resistance. This can lead to prediabetes and type 2 diabetes.e60dc2a1-f33c-4a05-9b50-8e3e8e59762982cd3ad0-d6f7-45f8-8e33-4c99d3e1fab0 Genetic makeup also affects how statins work. A variation of the SLCO1B1 gene can prevent statins from entering your liver properly and cause them to build up in the blood. This can lead to muscle problems, weakness, and pain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291d34ee9e-965e-4c55-8456-37665c19f478 People who are genetically statin-resistant also may also see little improvement in their cholesterol.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296f703166-3e93-4c35-885d-b921f745d478
Types of Statins and How They Affect Diabetes Risk Types of Statins Statin intensity is based on the amount that the statin lowers LDL cholesterol and at what strength, classified as high, moderate, or low intensity. The higher the intensity, the more the statin lowers LDL cholesterol. The choice of a statin depends on a person’s diabetes risk.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f665ccb-be65-49d0-be83-23648a911ba7 Here is how statin dosage is classified:e60dc2a1-f33c-4a05-9b50-8e3e8e597629d0d5668a-9152-4b95-a766-a967e028a47f
A meta-analysis of randomized controlled trials that included 149,000 people found a dose-dependent relationship: The higher the dose or more potent the statin, the greater the risk for people developing type 2 diabetes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4e15315-0dcd-45ae-ab3c-dbc2c3bdef52 “Statin use at a high intensity seems to increase markers of glucose control, such as hemoglobin A1C levels, and can lead to a higher incidence of type 2 diabetes if you’re already at risk for diabetes,” says Ashish Sarraju, MD, cardiologist at Cleveland Clinic in Ohio.
Benefits vs. Risks of Statins for People with Diabetes Benefits vs. Risks Not everyone who takes a statin will develop type 2 diabetes, Dr. Kim says. “For people who are at high risk of cardiovascular disease, the benefits of statins in reducing their risk of heart attacks, strokes, and other cardiovascular events usually outweigh the potential risk of developing diabetes,” she says. In addition to speaking with your doctor, you can check your risk for cardiovascular disease with the American College of Cardiology’s risk estimator tool . Data may suggest that statin risks are greater among people already at risk of type 2 diabetes, Dr. Sarraju says. These risk factors can include elevated glucose levels, high triglycerides , and obesity. “For people who are not in this situation, the excess risk of diabetes with statins is likely very low and negligible in many cases,” he says. When talking to patients about high-intensity statin doses and type 2 diabetes, Sarraju says he discusses the data behind the correlation. He also notes other ways to mitigate the risk of type 2 diabetes, including exercising, improving diet, and losing weight . “Statin therapies reduce risk even in patients with diabetes, so on the whole, if there is a strong indication for statins, the benefits are more likely to outweigh the risks,” he says.
The Takeaway Research suggests that statins, often prescribed to reduce cholesterol and lower the risk of heart disease, may increase risks associated with type 2 diabetes. Higher doses of statins and more potent types can further increase the risk of diabetes progression. To reduce the risks of statins and type 2 diabetes, doctors recommend lifestyle changes such as improving your diet, increasing physical activity, and losing weight.
Resources We Trust Centers for Disease Control and Prevention: Statins and Diabetes: What You Should Know Cleveland Clinic: What’s the Connection Between Statins and Diabetes? Mayo Clinic: Statins: Are These Cholesterol-Lowering Drugs Right for You? UC Davis Health: 8 Ways to Reduce Your Risk of Heart Disease
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