New Statin Guidelines and Diabetes, Are You Confused?
New cholesterol guidelines can be confusing for those with type 2 diabetes. We have dug a bit deeper to help you understand if you need a statin.
It appears that if some doctors have their way, millions more people will be added to the list of those taking statin drugs. At least that is how it seems when one reviews the new guidelines and risk calculator issued by the American Heart Association (AHA) for how to reduce the risk of heart disease. But if you have diabetes, you may be confused.
What the guidelines say
A team of experts from the AHA and the American College of Cardiology have stated that reducing one’s low-density lipoprotein (LDL) cholesterol levels to certain values is no longer the gold standard for determining a person’s risk of developing heart disease over 10 years. Now they believe each individual’s risk factors should be evaluated. That sounds reasonable.
Some of those risk factors include being obese, already having heart disease, being African-American, having high blood pressure, having an LDL level of 190 mg/dL or greater, having a family history of heart disease, or being middle-aged with type 2 diabetes.
Statins and diabetes
If you fall into the latter group, you may be confused. Haven’t studies shown that statins can raise blood glucose levels and/or hemoglobin A1c and/or the risk of type 2 diabetes?
Yes. For example:
A study published online January 9, 2012 in the Archives of Internal Medicine reviewed data from 153,840 postmenopausal women who participated in the Women’s Health Initiative. They reported a 48 percent increased risk of developing type 2 diabetes among women taking statins, including simvastatin, lovastatin, pravastatin, fluvastatin, and atorvastatin.
A more recent article (2013) appearing in Cardiovascular Diabetology pointed out there is “conflicting data…regarding the diabetogenic effects of some statins.” However, the Food and Drug Administration has mandated the labeling of all statins to indicate “an effect of statins on incident diabetes and increase in hemoglobin A1c and/or FPG [fasting plasma glucose].”
The review goes on to note that “the literature suggests that the beneficial effects of most statins on CV [cardiovascular] risk continue to outweigh their diabetogenic risks.” That may be true for some patients with type 2 diabetes, and indeed some patients are already prescribed these drugs.
But a fear among people with type 2 diabetes who are currently not taking statins is that the scene is about to change.
What should you do?
If you have type 2 diabetes and are not taking statins, be prepared because your doctor may recommend them. You have several choices.
- You can accept whatever your doctor says and take the drugs
- You can absolutely refuse to take the drugs
- You can arm yourself with as much information about statins (including side effects), possible alternatives to these drugs, and your risk factors for cardiovascular disease. Then when you visit your doctor, you will be prepared to ask informed questions.
Do you really need to take a statin, and if the doctor believes you do, what are the reasons?
What impact does the doctor believe the statins will have on your blood glucose and hemoglobin A1c levels?
Why does the doctor believe the benefits outweigh the risks in your case?
What alternatives do you have to taking statins? Have you made significant dietary changes to lower your cholesterol? Do you exercise regularly? Have you tried any cholesterol-lowering natural supplements?
Many clinicians and other experts do not agree with the new guidelines for statin use. Some say the significant increase in prescriptions are just about profits for the pharmaceutical companies and their shareholders.
Other comments include concern about the 20 to 30 percent of statin users who experience muscle damage from the drugs or the fact that the drugs can cause liver damage so regular monitoring is required.
As I did a quick review of various diabetes forums, I found many people with diabetes are confused, upset, and even angry about the new statin guidelines. Turn those emotions into positive actions: do your homework, ask questions, and look for alternatives to taking more drugs.