Summary
- Statin therapy has a well-established role in the treatment of high cholesterol and reduction of cardiovascular disease risk.
- Generally, statin therapy is considered safe and has a side effect profile with a low incidence rate that is also reversible.
- Statin therapy in patients with increased cholesterol or existing cardiovascular disease has been reported to potentially contribute to diabetes mellitus (DM).
- Statin medications may cause an increase in blood sugar that can potentially lead to DM or similar signs and symptoms of DM.
- For secondary prevention of cardiovascular events, statin therapy has been established. However, when it comes to secondary prevention the risk-benefit of statin therapy is less clear.
Clinical Data
There is a relatively decent amount of data that assesses the effects of statin therapy on the induction of type 2 diabetes mellitus (T2DM). In a retrospective cohort study, 265,414 patients aged 40-70 years of age were evaluated for statin-induced DM[1]. In this study group, 17.9% of the patient were treated with statins. In the four years this study was conducted, there were 5,157 new cases of cardiovascular disease and 11,637 new DM diagnoses. The results showed that low-intensity statin therapy in which the patient was over 50% adherent was associated with an increased risk of DM in those with low or intermediate baseline CV risk. In patients with high CV risk, the same was not true and there was no association. In patients that started statin therapy with low CV risk, no CV protective benefit was observed. The researchers calculated the number needed to harm (NNH) for one patient treated with a low-intensity statin that was above 50% adherent as 40. In those with intermediate and high CV risk, the NNH was 50 and 200, respectively. This study concluded that low-dose statin therapy in those with high CV risk is beneficial, however may be detrimental to those with low CV risk.
A meta-analysis was performed to investigate the association of statins and DM further [2]. The analysis identified studies in the Embase, Cochrane, and PubMed databases. In total there were 29 trials included in the analysis that consisted of 163,039 subjects. The analysis found that statin medications significantly increased the likelihood of patients developing DM by 12%. Based on the results of the study, it also seems as though higher intensity statin medications such as atorvastatin and rosuvastatin have higher associated risks of leading to DM than do low-intensity statins. Looking further into the drug information data according to Lexicomp, atorvastatin’s adverse events include endocrine & metabolic disorders such as DM. It is stated that the risk of this adverse event is up to 6% [3].
References
- Porath A, Arbelle JE, Fund N, Cohen A, Mosseri M. Statin Therapy: Diabetes Mellitus Risk and Cardiovascular Benefit in Primary Prevention. Isr Med Assoc J. 2018;20(8):480-485.
- Thakker D, Nair S, Pagada A, Jamdade V, Malik A. Statin use and the risk of developing diabetes: a network meta-analysis. Pharmacoepidemiol Drug Saf. 2016;25(10):1131-1149. doi:10.1002/pds.4020
- Atorvastatin Drug Information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc.
