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More News About Statins and Diabetes
Statin drugs have revolutionized cardiology, reducing heart attack and stroke risk by upwards of 30 percent in those who take them as prescribed and achieve their target cholesterol goal. The first statin drug, Mevacor (lovastatin), was approved by the FDA in 1987. Since then, a host of more potent statins have been introduced, including Pravastatin, Zocor, Lipitor, Lescol, Crestor, and Livalo. With generic versions of the older statins now available, their use has become widespread. It is estimated that about 20 million Americans are currently taking statin drugs.
In 2010 and 2011, several reports surfaced linking statin drugs to a slightly higher risk for adult-onset diabetes. I discussed one of those studies in a post last year. In general, those on higher doses of statins appear to be most vulnerable, as do those who already have risk factors for diabetes (including obesity and metabolic syndrome).
A recent study from Taiwan, published in the Journal of the American College of Cardiology, found a very slight increase in diabetes incidence in those who used statins over the course of 7 years. Only 2.1% of non-statin users developed diabetes, while 2.4% of statin users became diabetic. Statistically, this means that the incidence of diabetes rose by about 15 percent. On the other hand, statin users were nearly 20 percent less likely to suffer a heart attack during the study period, and 40 percent less likely to die during a hospitalization.
Lately there has been a great deal of controversy in the medical community as to who should receive statins and who should not. While some argue strenuously that the benefits outweigh the risks for all patients, most cardiologists, myself included, prefer an individualized approach. If you have cardiovascular disease then statins are considered the standard of care. If you have risk factors but no known heart disease and you have a borderline cholesterol number, consider a coronary calcium score, which may help you doctor decide whether statin treatment might be helpful. If your LDL (bad) cholesterol is very high despite your best efforts, then a statin may also be advisable.
Although the number of heart attacks and strokes prevented by statins is substantially higher than the number of new cases of diabetes, it makes sense to try to avoid high doses of statins unless necessary. By working hard on a healthy diet, committing to regular exercise, and maintaining a healthy lifestyle, most people who require statins are able to limit the dose of medication that they require.
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