Q&A With Heart Experts: In this series, heart specialists answer common questions about statins and heart health.
Do statins cause diabetes?
Early statin studies show a small increase in newly diagnosed diabetes. Further analysis proved that these patients had at least one risk factor for developing diabetes, including obesity, increased abdominal weight, high triglyceride level, low HDL cholesterol level, high blood sugar level, and high blood pressure.
In a recent meta-analysis that included 22 clinical trials, statins lowered the chance of dying from any cause (not just heart disease). It also showed a reduction in the risk of stroke and heart attacks. This analysis also considers various potential harms of statins, including the risk of diabetes. Overall, statin use did not show a statistically significant increase in the risk of new-onset diabetes. This meta-analysis had one trial (out of the 22 trials), JUPITER, that showed an increase in risk of diabetes with high-intensity statin. Other high intensity statin trials included in the analysis did not have this finding. This increase in new onset diabetes found in the JUPITER trial was primarily among people who already had risk factors for developing diabetes.
On the other hand, there is strong evidence that shows statins are especially beneficial in patients with diabetes. For example, a meta-analysis of 24 studies, including over 2.15 million patients with diabetes, showed a benefit in patients with moderate- or high-intensity statins. In patients with diabetes on statin therapy, there was a reduction in heart attacks and strokes compared with placebo. There was a 20-25% lower risk of cardiovascular events in people taking statins compared with those who were not on statins.
Overall, about 1 in 200 patients at risk for crossing a threshold from pre-diabetes to diabetes on statin medication will do so over five years. Because the risk of developing heart disease is very high in those with coronary artery disease, diabetes, obesity, metabolic syndrome, and prediabetes, the reduction in heart events justifies the use of statins in high-risk individuals. In other words, cardiovascular benefits from taking a statin outweigh the small risks from slightly higher blood sugar.
Key Points
- Statins reduce the risk of heart attacks and strokes.
- Statins may slightly raise blood sugar, but this mostly happens in people who already have risk factors for diabetes like being overweight, having high blood pressure, or high blood sugar.
- Only about 1 in 200 people taking statins shift from having a diagnosis of “prediabetes” to “diabetes” over 5 years.
- The heart benefits of statins are much greater than the risk of slightly higher blood sugar – especially for people at high risk of heart disease.