Statins. Everyone takes them, right? That’s why after I was diagnosed with type 1 diabetes in 2002, I didn’t question my doctor when he told me I’d probably need to start taking a statin. It made sense, since diabetes put me at a higher than normal risk for heart disease, and statins would dramatically lower that risk. My doctor also said that statins came with few adverse effects. He said, “It’s a pill you take at night. If it makes your muscles hurt, we’ll just switch you over to a different statin.”
During my first year with diabetes I ate a low carb diet that included a lot of meat and eggs, so I wasn’t surprised when a blood test showed my cholesterol levels were high. The word statin was in the back of mind all of the time. But the idea of muscle pain frightened me. So I tried cutting out eggs, meat, and cheese. That had little effect on my cholesterol. My HDL cholesterol was always over 70 (which was considered good). But I couldn’t get my LDL under 120, no matter what I did or didn’t eat. My doctor was adamant that a person with diabetes should have an LDL of under 100. So while I didn’t question the need to lower my cholesterol, I still questioned the need to take a statin. I asked a few other doctors for their opinions and they all seemed to think it was crucial – perhaps as important for heart health as keeping my blood sugar levels in range.
Statins lower cholesterol levels by inhibiting an enzyme that plays a central role in the production of cholesterol in the liver. Understanding that is a lot easier for me than understanding what cholesterol actually is. If you get confused about HDL and LDL and non LDL, don’t worry. You’re not alone. For a basic run-down on cholesterol, I encourage readers to read the post What Is Cholesterol? on the blog War On Insulin, written by Peter Attia who eats a very high fat diet. (Attia follows in the footsteps of Gary Taubes, author of Why We Get Fat, and challenges the notion that the fat found in meat and dairy products elevates cholesterol levels in the blood. For the purposes of this article, I want to focus not on cholesterol, but on statins, so I’m leaving that discussion for now.)
Because every doctor I’ve talked to about statins has encouraged me to take them, I have dutifully done so. But when I read about a paper published in January in the Archives of Internal Medicine which found statin therapy was associated with an increased risk for diabetes, about 48% overall, I began to wonder about statins again. It doesn’t seem to be clear why statins might lead to diabetes, especially given their anti-inflammatory effect. In my case, I’m already insulin dependent, so diabetes isn’t exactly a big fear. But I do wonder if the statin is causing insulin resistance and, therefore, I require more insulin than I would if I were not taking a statin.
Last month the US Food and Drug Administration (FDA) issued new labeling changes for the entire statin drug class. The change that caught my attention most was that now all statins must come with a warning noting that there have been reports of increased blood sugar and hemoglobin A1c levels with use.
In response to this, Amy G. Egan, MD, MPH, Deputy Director for Safety in the Division of Metabolism and Endocrinology Products at the FDA told Medscape, “These were fairly routine labeling changes for us. However, because statins are so widely used, there is a heightened awareness by the public when we make any safety-related labeling changes to this class of drugs. These changes do not in any way alter the risk-benefit calculus for this class of drugs. We continue to believe that the benefits of statins far outweigh their risks, but we do want clinicians and patients to be aware of their side effects so that they can be used in the most safe and effective manner possible.”
Risk versus benefit seems to be the general medical consensus regarding statin use. According to Dr. Zachary Bloomgarden, Clinical Professor at Mount Sinai School of Medicine “If in a given person the chance of having coronary disease, stroke, etc is very low in the first place then the absolute benefit (the product of the underlying event rate times the percent reduction with statin) might well be far less than the likelihood of diabetes, or of a severe muscle reaction, and it might indeed not be a good idea. This is why currently we stratify risk based not only on the cholesterol but also on other risk factors, family history, etc, and recommend statins for LDL>70 if a person has, say, already existing coronary disease, but not unless the LDL >160-190 if they are completely healthy and at low risk.”
Essentially, it all boils down to an understanding of numbers. I don’t, however, fully understand the numbers (and I have an MBA in finance!). While I do understand how a doctor must assess risk, I don’t understand why in my particular case the statin is so critical. I know that I can keep my cholesterol in the range of 120 without a statin. If the statin might be causing my blood sugar to be higher, and higher blood sugar leads to increased risk of cardiovascular complications, then why am I taking the statin? It’s not as though my cholesterol is way out of the normal range. In fact, it’s exactly in range for a healthy person. Maybe if I weren’t taking a statin my A1c would be 6.0% instead of 6.4%. Wouldn’t that qualify me as healthy, despite diabetes?