Statins are widely used in for the primary prevention of atherosclerosis - plaques containing cholesterol that progressively block blood vessels. They are also used in ‘secondary prevention’ of further problems in patients who have already had heart disease, or strokes diagnosed. So statins have an established role in conventional medicine and are used extensively. They are safe for type 2 diabetic patients as part of the management of metabolic disease (which includes high blood pressure, obesity, increased blood fats and, of course, raised blood sugars). They work by preventing cholesterol formation in the liver and thus reducing blood fat levels.
However, there has been concern about the association between statin therapy and developing diabetes1. Meta-analyses of trials in several population groups treated with statins showed:
In 14 primary prevention trials involving 46,262 participants, statins increased the absolute risk of developing diabetes by 0.5% and at the same time reduced mortality by 0.5%.
In 15 secondary prevention trials involving 37,618 patients, statins reduced mortality by 1.4%.
In both studies, the risk of developing diabetes was significantly higher in statin patients (3% vs 2.4% in placebo.
The JUPITER trial published in the New England Journal of Medicine in 2008, compared Rosuvastatin (Crestor) to placebo in elderly patients with no history of cardiovascular disease or elevated blood cholesterol, but high C-reactive protein levels. The trial showed a significant decrease in cardiac morbidity and mortality in the treatment group, but there was also an increase in physician-reported diabetes in the statin group (270 reports of diabetes, vs. 216 in the placebo group; P=0.01). This finding led to further studies that examined the incidence of new diabetics in all statin studies versus placebo.
No single study showed an increase in diabetes prevalence in the statin group, but grouping all of the studies together showed a 9% increase in new diabetes diagnosis in statin patients.
Another study examined the incidence of diabetes in studies comparing intensive treatment with statins (high doses of statins) versus moderate therapy (low dose of statins). Once more, individual studies did not show an increase in diabetes prevalence, but grouping of study results showed a 12% increase in prevalence of diabetes in the intensive care group. Despite this, it should be emphasized that statin therapy, and intensive statin therapy, has been associated with significant (circa 20%) reductions in cardiovascular morbidity and mortality.
The studies conclude that despite the slight increase in the risk of diabetes, the beneficial effects of statins outweigh the risk. In other words, studies that meet their ‘primary endpoints’ with statin therapy (reductions in blood values, incidence of heart attacks or strokes etc) are considered successful and endorse the use of statin therapy.
Diabetes is a systemic disease that affects blood sugar levels, raises blood fats and causes damage to small blood vessels and large blood vessels in different ways. Atherosclerosis is a disease that affects larger blood vessels and is one of the sequelae of diabetes. In 2012, the Food and Drug Administration (FDA) advised caution when treating pre-diabetic patients with statins due, in part, to the findings that ‘treatment’ may lead to the development of diabetes itself.2
Doctors should be aware about the possible development of diabetes in patients with intensive statin therapy. The first priority is to consider lifestyle management in patients with low-risk of cardiovascular disease. The evidence for benefits of statin therapy so far rests with patients with risk factors for large vessel disease.
Our work in recent years has focused on how to manage not only the glucose levels in diabetic patients, but also how to reduce the risk of the myriad complications. Without doubt, lifestyle is essential, emphasizing - physical activity, measured eating, not smoking and the use of dietary supplements such as Ascarx™, which improves cellular metabolic functions and reduces high levels of glucose and fat in the blood which cause damage to blood vessels and lead to further disease and disability. Ascarx™ prevents the development of metabolic disease. There is no doubt that with time and more research, we will unravel the mechanisms by which diabetes causes disease and how we may intervene to cure this disease. It is worth pausing to consider the wealth of the natural world in providing safe treatments for diabetes. These compounds, like Ascarx™ are proving effective and complementary, or alternative to, conventional medications that may sometimes cause unforeseen side-effects.
1. Crandall JP, Mather K, Rajpathak SN, Goldberg RB, Watson K, Foo S, Ratner R, Barrett-Connor E, Temprosa M.Statin use and risk of developing diabetes: results from the Diabetes Prevention Program.BMJ Open Diabetes Res Care. 2017 Oct 10;5(1)
2. Bharti Chogtu, Rahul Magazine, and KL Bairy.Statin use and risk of diabetes mellitus.World J Diabetes. 2015 Mar 15; 6(2): 352–357