On Tuesday January 10, 2012, the USA TODAY posted on their front page, Heart drugs tied to diabetes, statins raise the risk of developing diabetes. The article stated that one in four Americans older than 45 face a higher risk of diabetes because they take cholesterol lowering statins, the nation’s most prescribed drug. JoAnn Manson co-author of the study in Archives of Internal Medicine states that 6.4% of the 153,000 women in the Women’s Health Initiative Study developed diabetes during eight to nine-year follow-up. That rate rose to 9.9% among statin users. Studies have also linked statins to men as well. These cholesterol lowering medications, the statins have been used since 1987 and doctors write 255 million prescriptions a year each year.
At this point no one knows why over an extended period of time diabetes may develop. The long-term effect of statins along with many other newer medications are not known. For a time there were some who said, since the statins lowered the risk of heart attack and stroke, they should be put into the water supply to lower the risks. However, this study should hamper the enthusiasm and get everyone to pause and think. What are the long-term consequences of giving any medication? Which is likely to kill me the quickest, the medication or the disease? This is a legitimate question.
According to the National Center for Health Statistics statin sales topped 19 billion in 2010. There is big money in the statins. So who should take a statin? Statins can effect the liver and cause muscle damage. One statin, Baycol, was removed from the market. Now we see an increased risk of diabetes. At this point I recommend in my patients if they are at risk, previous heart attack, coronary disease, stroke, strong family history, diabetes, high cholesterol levels, a statin should be considered. Close monitoring for side effects must be maintained. For everyone else the individual risk profile needs to be the determining factor and not a logarithm. If a side effect occurs, I stop the medication. The stress of even a minor side effect may not be worth the benefit. Remember a side effect can alter the stress chemistry of the body. In some individuals the fear of taking a medication can be a real problem causing stress chemicals to be activated. Are there other ways to accomplish the goal of a statin, a better diet, or exercise?
What is the bottom line. I would not recommend the routine use of a statin. The use of a statin should be individualized based on risk. The use should also be based on how an individual reacts to taking medication. Will they be scared to death? A patient should also be given alternatives in reaching the goals the statin strives to achieve. There is a use for statins. Our eyes must stay open as we do not know the long-term consequences as demonstrated by this article as well as others.