Statins in Diabetes Treatment: Weighing the Risks and Benefits
Key takeaways:
Diabetes is a complex medical condition that can greatly increase your risk of heart disease. It’s often linked to high cholesterol, which also raises your risk of heart disease.
Statins are a class of medications used to lower cholesterol. They’re often prescribed to people with diabetes to help decrease the risk of heart disease.
When you take a statin, there’s a small risk of developing or worsening your diabetes. But the benefits of statins far outweigh the small increase in risk.
If you have diabetes, there are other potential health problems you need to be aware of. High cholesterol and heart disease are both linked to diabetes. And just like diabetes, they can also lead to serious consequences, like a heart attack or stroke.
To treat high cholesterol and prevent heart disease, many healthcare providers recommend statins for people with diabetes. But do they really help? And are there any risks to taking them? Keep reading to learn more.
Why is high cholesterol dangerous?
High cholesterol can lead to plaque (fatty buildup) lining your arteries. This can decrease blood flow to your organs and other tissues throughout the body. High cholesterol and atherosclerosis can lead to many health problems, including:
Heart attack
Stroke
Kidney disease
Peripheral artery disease
How does diabetes affect cholesterol levels?
Atherosclerosis is fairly common, especially as you age. But diabetes increases your risk of developing atherosclerosis faster and earlier than usual. People with diabetes tend to have lower levels of “good” cholesterol (HDL) and higher levels of “bad” cholesterol (LDL).
The body makes more cholesterol when you have diabetes, but it can’t absorb it as well. All of these factors can make conditions such as heart disease and stroke more likely. In fact, the risk of heart disease is two to four times higher for some people with diabetes.
What are statins?
Statins are a group of medications that block the liver’s ability to make cholesterol. To the liver, statins look a lot like one of the building blocks of cholesterol. So when your body tries to use statins to make cholesterol instead of the protein it needs, it simply doesn't work. And it prevents your body from making more cholesterol.
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Statins are rated according to how well they decrease LDL levels at different doses. This refers to the statin intensity. How much cholesterol your liver can make depends on the dosage and intensity of the statin that you’re taking.
When are statins typically recommended for diabetes?
The American Diabetes Association recommends a statin for all adults ages 40 to 75 with Type 2 diabetes. This is to prevent heart disease related to atherosclerosis.
Even if you don’t have diabetes, a statin is usually recommended for any adult with an LDL cholesterol level above 190 mg/dL. But the decision to start statin therapy is usually based on your other risk factors for heart disease. These can include:
Smoking
A family history of heart disease
High blood pressure
Gender (men have a higher risk than women)
Age (people over age 65 have a higher risk)
Heavier body weight
How do statins work in people with diabetes?
Statins help with diabetes because their effects go beyond just lowering cholesterol levels. Research shows that statins:
Reduce inflammation
Improve the function of the lining of small blood vessels
Reduce clotting
These are important functions of statins in diabetes treatment. That’s because diabetes is a complex medical condition. Since diabetes raises blood sugar levels, it also affects the lining of small blood vessels. And it can cause inflammation. This can increase the chances of complications like stroke and heart attack.
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Statins have a direct effect on many diabetes complications. This makes statins an important part of diabetes treatment.
Do statins cause diabetes or make it worse?
Research shows that there’s a small increase in diabetes in people who take statins. But it’s not entirely clear why. Experts have found a few patterns when people develop diabetes after taking statins:
The risk of diabetes is greater with higher doses versus moderate or lower doses.
The risk of diabetes is higher for people who are already at risk of developing diabetes.
The onset of diabetes was only 2 to 4 months earlier in those taking statins versus those who didn’t take statins.
If you already have diabetes and start taking a statin, your diabetes may get worse. There’s evidence that statins may cause:
Higher blood sugars
Higher hemoglobin A1C (HbA1C or A1C) levels
Increased insulin resistance
A need to start insulin treatment sooner
Even with these risks, providers have not changed their recommendations for statin therapy. That’s because statins have many beneficial effects in addition to reducing cholesterol. And experts believe the powerful effects of statins far outweigh any risks.
Your provider may want to keep an eye on your blood sugar and A1C after you start a statin. This is especially true if you have diabetes or other risk factors for developing it.
Statins and diabetes: Which one is the best option?
There are several statin choices available. This can make it challenging to know which one is best to use. When finding the best statin for you, you and your provider will consider several factors, including:
Your starting cholesterol level
Your other risk factors for heart disease and stroke
Other medications you’re taking
With this information, your provider will also consider statin intensity. This will help them figure out which statin will get you to your cholesterol goal the fastest.
The intensity rating is important, but there are other factors to consider, too. Your provider will consider how the statin may interact with your medications, and any other medical conditions you have.
Popular statin options your provider may choose from include:
Atorvastatin (Lipitor)
Fluvastatin (Lescol)
Lovastatin (Mevacor)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Pitavastatin (Livalo)
Statins, like all medications, come with potential side effects. Side effects vary among different statins, but they may include:
Sore and stiff muscles
Joint pain
Digestive discomfort, diarrhea, or constipation
Headaches
Sore throat
Tiredness
Your healthcare provider will adjust the statin and its dose based on how high your cholesterol is at the start and how well it decreases. They will also monitor you for any side effects.
The bottom line
Diabetes can make it much more likely to have heart disease. If you have diabetes, you’re more likely to have high cholesterol as well. Statins can help lower cholesterol and decrease your risk of heart disease. That’s why statins are often part of diabetes treatment. Although statins can worsen diabetes in some cases, the benefits are far greater than the risks. If you have diabetes, talk to your provider to find out if using a statin is a good fit for you.
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References
American Diabetes Association. (2018). Cardiovascular disease and risk management: Standards of medical care in diabetes – 2019. Diabetes Care.
Bertoluci, M., et al. (2017). Cardiovascular risk assessment in patients with diabetes. Diabetology and Metabolic Syndrome.
Maganti, K. (2019). Key points from the 2019 ACC/AHA guidelines on the primary prevention of cardiovascular disease. American College of Cardiology.
Mansi, I. A., et al. (2021). Association of statin therapy initiation with diabetes progression: A retrospective matched-cohort study. JAMA Internal Medicine.
Mihos, C. G., et al. (2014). Cardiovascular effects of statins, beyond lipid-lowering properties. Pharmacological Research.
Pinal-Fernandez, I., et al. (2018). Statins: Pros and cons. Medicina Clinica.
Robinson, J. G. (2015). Statins and diabetes risk: How real is it and what are the mechanisms?Current Opinion in Lipidology.
Sattar, N., et al. (2010). Statins and risk of incident diabetes: A collaborative meta-analysis of randomized statin trials. Centre for Reviews and Dissemination.
Simonen, P. P., et al. (2002). Diabetes contributes to cholesterol metabolism regardless of obesity. Diabetes Care.
