Benefits of statins outweigh dangers, report says
The benefits of taking cholesterol-lowering medications outweigh the increased risk some patients have of developing diabetes from using the drugs, a report out Thursday says.
Patients who were at higher risk for diabetes were 39% less likely to develop a cardiovascular illness on statins and 17% less likely to die. Patients who were not already at risk for diabetes and were taking statins had a 52% reduction in cardiovascular illness, and no increase in diabetes risk.
"When we focus only on the risk (of diabetes) we may be doing a disservice to our patients," says lead author Paul Ridker of Brigham and Women's Hospital in Boston. "As it turns out for this data, the hazard of being on a statin is limited almost entirely to those well on their way to getting diabetes."
Statins are proven to lower heart attacks and strokes, but after several studies showed that some people are at a slightly higher risk of developing diabetes when on statins (9.9%, compared with 6.4% for those not on statins), the Food and Drug Administration required statin makers in April to add warnings to labels saying they can raise blood sugar levels.
"We're concerned that many diabetics stopped taking statins because of those warnings," says Ridker, whose findings were in The Lancet. The analysis used the results from a study of 17,000 patients in 2008. Ridker was the principal investigator for that study, which lead many physicians to prescribe statins for preventive uses in people who don't have heart disease.
Some experts don't agree with the new findings and think that too many physicians prescribe statins anyway. About one in four Americans over age 45 takes a statin, according to the National Center for Health Statistics.
Prescribing statins to people who don't have heart disease "is still a big issue," says physician Eric Topol, director of the Scripps Translational Science Institute in San Diego. "Per 100 people, you have two heart attacks less and one increase in diabetes. They're trying to say it benefits more than it harms, but the benefit is so small."
Topol says the patients he sees aren't aware of the risks of statins. "The patient doesn't know this might make their protection for heart attack marginally better but it also could backfire by inducing diabetes," he says.
Many patients who become diabetic are often put on statins anyway, Ridker says, because heart disease is the No. 1 killer of diabetic people. Nearly 26 million Americans have diabetes, the American Diabetes Association says.
"The 'take home' for clinicians is to know what the risk factors are, but very often if you throw diabetes into the mix, it's cardiovascular disease that will kill them," says Larry Deeb, former president of medicine and science for the American Diabetes Association.
By no means, though, should everyone with diabetes be on statins, Deeb says -- unless they have other risk factors for heart disease. Even then, Topol says, the best prevention is exercise and diet.
"Many people can't tolerate statins," Topol says. "Diabetes alone is still not a commitment to life-long statin use."
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