A shocking new study by researchers in Finland suggests that statins may increase the risk of diabetes, perhaps as much as 46 percent. This news has led to a flood of questions from concerned patients, asking if they should still be on their cholesterol lowering medications.
As a practicing cardiologist, it is my responsibility to tell my patients that statins (cholesterol lowering medications such as Lipitor, Crestor, and Zocor) do have many great benefits. Not only do they lower cholesterol, but if someone has had a heart attack, bypass surgery or stent, there is no doubt that taking these medications can also decrease the risk of another coronary event, or death. I believe physicians and alternative practitioners who deny the benefits of statins entirely are on a fringe.
But, what if statins are really not as effective as we think, and have side effects that we have not yet completely realized? Could it be that some of these statin critics are correct?
History can be a great teacher as there are many instances in medicine where conventional wisdom has turned out to be wrong. Forty years ago, we did not know that environmental toxins could cause cancer or that stomach ulcers were often caused by bacteria. Could conventional wisdom also be wrong when it comes to statins?
According to this Finnish study, statins, especially in higher doses, markedly increase the chance that someone may develop Type II diabetes. This likely occurs because these medications seem to decrease insulin production and inhibit the ability of the body to process insulin appropriately.
In addition to diabetes, there are other possible ill effects of statins. An estimated 10-20 percent of people taking statins experience muscle aches that lead to them stop their medication. Others complain of a kind of brain fog, where they cannot think clearly. Recent controversial guidelines by the American Heart Association and the American College of Cardiology suggest that as many as 10.4 million more Americans with no known heart disease should be on statins. Thus a new and more critical look is needed in view of this new information about the risk of diabetes.
The error lies in prescriptive practices. There has been an evolution of statins from a medication benefiting a few, to a medication prescribed to the many. Doctors often forget that many people are scared of taking a statin. A vital role of a physician, or any health care practitioner, is to educate, and to listen to patients' concerns. Statins are a force for good when use is limited to clear beneficiaries, as in those who have known cardiovascular disease. The risk of developing diabetes from a statin in this group of people may still be higher, but represents a case of the good (lower risk of a recurrent cardiac problem) outweighing the bad (side-effect of the medication).
For the much larger group of patients who are looking to prevent a cardiac problem and may not want to take the risk of being on a statins, the following approach may be in order.
- Promoting the beneficial effects of lifestyle change, and remembering that the best treatment for most people with Type II or borderline diabetes is losing weight and exercising, not necessarily stopping their statin.
- Individually assessing the risk that each person has of developing a cardiac problem in the future before treating healthy people who have high cholesterol levels with statins (sometimes using more advanced testing such as calcium scoring CAT scans).
- Understanding that no one should take a pill that causes side-effects every day of their lives if the goal is to prevent a problem at some time in the future,
- Involving each person in their decision to take medication, with a clear understanding of the possible benefits vs risk.
- Physicians acknowledging (or at least not showing exasperation) and discussing alternative therapies with patients who bring it up in conversation. Some of these therapies, such as red yeast rice, may actually be effective, and have less side- effects.
I applaud the European researchers who have opened a new chapter in the book on statins, and forced us to rethink a cardiovascular treatment that has become routine. Now, it is up to all of us to "Finnish" the story.