Statin use in postmenopausal women is associated with a significantly increased risk of diabetes mellitus, research shows. Association does not mean causation, however. New data from the Women's Health Initiative (WHI) hint that the risk of diabetes is higher than suggested by previous studies, with investigators reporting a 48% increased risk of diabetes among the women taking the lipid-lowering medications.

"With this study, what we're seeing is that the risk of diabetes is particularly high in elderly women, and this risk is much larger than was observed in another previous meta-analysis," senior investigator Dr Yunsheng Ma (University of Massachusetts Medical School, Boston). "For doctors treating patients, we would like them to really look at the risk/benefit analysis, especially in different age groups, such as older women."

Annie Culver (Mayo Clinic, Rochester, MN), a pharmacist and lead investigator of the study, published online January 9, 2012 in the Archives of Internal Medicine, said that "close monitoring and an individualized risk-vs-benefit assessment is really a good thing, as well as an emphasis on continued lifestyle changes." Culver added that as the population ages, and because these patients have a higher vulnerability to diabetes anyway, monitoring for diabetes in statin-treated patients becomes more important.

Previously published data on statins and diabetes risk

Recently published data highlighted the potential risk of diabetes with statin therapy. In June, Dr Kausik Ray (St George's University of London, UK) and colleagues published a meta-analysis of PROVE-IT, A to Z,TNT, IDEAL, and SEARCH—five trials testing high-dose statin therapy—and found a significant increase in risk of diabetes with higher doses of the lipid-lowering drugs. A meta-analysis published in the Lancet in 2010 by Dr Naveed Sattar (University of Glasgow, Scotland) also showed that statin therapy was associated with a 9% increased risk of diabetes.

In the present study, Culver, Ma, and colleagues analyzed data from the WHI, an analysis that included 153 840 postmenopausal women aged 50-79 years old. Information about statin use was obtained at enrollment and year 3; the current analysis includes data until 2005. At baseline, 7.0% of women were taking statins, with 30% of women taking simvastatin, 27% taking lovastatin, 22% taking pravastatin, 12.5% taking fluvastatin, and 8% taking atorvastatin. During the study period, 10 242 incident cases of diabetes were reported.

"The association between diabetes risk and statin therapy was not observed with any one type of statin, and it seems to be a class effect," said Ma.

Significantly increased risk of diabetes was observed in white, Hispanic, and Asian women (an increased risk of 49%, 57%, and 78%, respectively). Among African Americans, who made up 8.3% of the population studied, there was a nonsignificant 18% increased diabetes risk associated with statin use at baseline. Statin use and diabetes risk was also observed in women across a range of body-mass indices (BMIs <25.0, 25.0-29.9, and >30.0 kg/m²). Women with the lowest BMI (<25.0 kg/m²⁾, appeared to be at higher risk of diabetes compared with obese women, a finding the investigators speculate is related to phenotype or hormonal differences between the women.

In an editorial Dr Kirsten Johansen (University of California, San Francisco), editor of the Archives, noted that the increased risk of diabetes in women without CVD has "important implications for the balance of risk and benefit of statins in the setting of primary prevention, in which previous meta-analyses show no benefit on all-cause mortality."

Ma agreed, noting that statins are used with increasing frequency, including in primary prevention, and—based on the JUPITER trial—in patients with normal LDL cholesterol but elevated C-reactive protein (>2.0 mg/L). In the present study, baseline statin therapy was associated with a significant 46% and 48% increased risk of diabetes in women with CVD and without CVD, respectively.

MY COMMENTS:

In biochemistry, we learned that glucose is the precursor of cholesterol: Glucose-6-Phosphate --> Pyruvic acid --> Acetyl CoA --> Cholesterol. Since Statins block the production of cholesterol by inhibiting HGA CoA reductase, statins may help accumulate blood glucose especially if the individual continues to consume excess carbohydrates which helps produce more blood sugar. Not exercising ads to this risk. Hyperglycemia is the main cause for developing type 2 diabetes mellitus.

It takes approximately 10- 12 years to develop diabetes from elevated blood sugar. Women on statins should make every effort to lose weight, exercise and eat low glycemic foods.

I do not give statins to patients without atherosclerosis. I use carotid ultrasound (CIMT) and heart scans to determine if there is plaque. Personal and family history are also important.

By checking A1c every 3-6 months elevated sugar can be prevented and diabetes risk averted. A heart attack will kill you faster than elevated sugar.

Elevated blood sugar can be treated aggressively though diet, exercise, lipoic acid, metformin, chromium and many other means.

Statins should not just be prescribed to everyone with elevated LDL…just to those with increased cardiovascular risk.

Statin therapy, along with my comprehensive nutritional supplementation protocol, give excellent results. I prove this by showing reversal of plaque and prevention of heart attack and stroke.