If you are among the tens of millions of
people who could benefit from taking a cholesterol-lowering medication, worries
about side effects may cause you to hesitate before filling your prescription,
said Dr Savitha Subramanian, an endocrinologist at the University of Washington
School of Medicine in Seattle.
اضافة اعلان
Statins, which help lower levels of LDL ( “bad”
cholesterol) in the blood, can cause side effects such as headache, muscle
pain, brain fog and fatigue. But one of the most worrisome among them for many
people is the increased risk of developing type 2 diabetes, in which the body
fails to properly regulate and use sugar (or glucose) as fuel.
While type 2 diabetes is a real concern, Subramanian
said, that does not mean you should automatically avoid statins. Here is why.
What are statins, and how do they work?
Statins have been used since
the 1980s to treat and prevent heart disease by lowering cholesterol levels in
the blood. Doctors recommend them to people who have had heart attacks or
strokes and to those at risk of such conditions because they have high
cholesterol.
While other lipid-lowering drugs exist, a majority
of adults who need such medications take statins, which work by inhibiting
liver enzymes that produce cholesterol. This prevents a build-up of fatty
deposits in blood vessels that could eventually clog them and reduces
inflammation that occurs when arteries are blocked. Together, these actions
lower a person’s odds of heart disease.
What is the link to
Type 2 diabetes?
Considering their
anti-inflammatory effects, researchers in the early 2000s thought that statins
might actually protect against diabetes. But in one trial published in 2008 in
the New England Journal of Medicine, researchers found that older, healthy
adults who were given 20 milligrams of rosuvastatin (Crestor) each day were
more likely to develop diabetes after about two years than those who were given
a placebo.
Before that study, “there was a sense that maybe
statins would reduce the risk of diabetes”, said Dr Jill Crandall, an
endocrinologist at the Albert Einstein College of Medicine in New York. “In the
end, we saw something completely different.”
Several other analyses have confirmed the link
between statins and diabetes risk, but the causes are still a mystery. So far,
studies in animals and clinical trials in people have suggested that statins
might make cells more resistant to insulin, a hormone that helps regulate
glucose levels in blood. When this happens, blood sugar levels can rise so much
that it increases the risk of Type 2 diabetes.
While all statins
can have this effect, it is most commonly seen with “moderate to high intensity
doses”, Subramanian said, such as 40 or 80 milligrams per day of atorvastatin
(Lipitor), or 20 or 40 milligrams of rosuvastatin.
What does this mean
for my own risk of diabetes?
Not everyone who takes a
statin will develop diabetes, said Dr Marilyn Tan, an endocrinologist at the
Stanford University School of Medicine in California. Of about 8,900 adults who
took rosuvastatin in the 2008 trial, for instance, 270 developed diabetes; 216
of the same number who took a placebo also developed the condition. One review
of studies from 2010 estimated that statin therapy was associated with a nine percent
increased risk of diabetes.
But that does not apply to everyone. An otherwise
healthy, younger person is at much lower risk for developing diabetes than
someone who is older and has other risk factors, Tan said.
The risk also rises if you are prediabetic, a
condition in which blood sugar levels are elevated. A statin might increase
blood sugar levels enough to tip a person from prediabetes into diabetes,
Crandall said.
“But the changes in blood sugar level are actually
pretty modest,” she added. “It doesn’t mean you’re at dramatically increased
risk from diabetes or diabetes complications.”
Even if you are taking statins, lifestyle choices
such as being active and following a healthy diet can reduce the odds of
developing diabetes, Tan said.
Still, fears of diabetes or other side effects can
make people hesitant to use statins, Subramanian said. If you have concerns,
discuss them with a health care provider who can help find the right statin and
dosage for you, she said. While high-intensity statins might increase the risk
of diabetes for some people, they are essential drugs for preventing heart
disease, and their benefits far outweigh the risks.
“Statins have such a bad rap,” Subramanian said.
“But the risk of developing diabetes should not deter anybody from starting to
take a statin.”
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