More Data about Statins and Glucose Metabolism

Posted On 2012-09-26 19:27:41
A recent study published in BMJ Open, adds more data about the relationship between statins and glucose metabolism. Rautio et al. from the Pirkanmaa Hospital District, Tampere, Finland examined whether the use of statins is associated with the incidence of type 2 diabetes (T2D) and changes in glucose metabolism among individuals at high risk for T2D, participating in 1-year lifestyle intervention in primary healthcare setting. In a prospective follow-up study in 400 primary healthcare clinics in Finland, a total of 10 149 individuals at increased risk for T2D were screened. Of these, 2798 non-diabetic individuals verified by a 2 h glucose tolerance test participated in the 1-year follow-up, which included lifestyle intervention. The primary outcome measures was incidence of T2D and fasting and 2 h glucose measured at baseline and follow-up. 

A total of 484 individuals (17.3%) used statins at the baseline. Of them 31 (7.5%) developed T2D during the follow-up, compared to 126 (6.5%) of statin non-users (OR 1.17, 95% CI 0.78 to 1.76, p=0.442). Interestingly, fasting glucose increased by 0.08 mmol/l in statin users, but remained unchanged in non-users, the difference being 0.074 mmol/l (95% CI 0.014 to 0.134) and remained significant even after adjustment for age, sex, baseline fasting glucose, the presence of cardiovascular disease (CVD), use of antihypertensive and/or coronary artery disease medication, weight and 1-year weight change (adjusted p=0.042).

The authors conclude that the incidence of T2D did not differ between the statin users and non-users. The finding that fasting glucose slightly increased in statin users in spite of lifestyle interventions suggests that the use of statins might have unfavourable effects on glucose metabolism and that statins might hamper beneficial effects of lifestyle intervention in people at high risk of T2D. Further, the authors state that the benefirts of statin therapy for the prevention of CVD in people with an increased risk are still unequivocal.

A recent review article in JACC, entitiled ‘The controversies of statin therapy: weighing the evidence.’ describes that debate whether statins, 3-hydroxymethyl-3-methylglutaryl coenzyme A reductase inhibitors, are safe to use has been raging since their introduction in 1987. The authors review evidence, from case reports to large randomized controlled clinical trials, for the possible adverse effects of statins on cognitive decline, cancer, and diabetes. The authors conclude that there is no increased risk of cognitive decline or cancer with statin use, but that statin use is related to a small increased risk of type 2 diabetes mellitus. However, the authors state that in view of the overwhelming benefit of statins in the reduction of cardiovascular events, the small absolute risk for development of diabetes is outweighed by the cardiovascular benefits in patients for whom statin therapy is recommended. 

1. Rautio N, Jokelainen J, Oksa H, Saaristo T, Peltonen M, Vanhala M, Puolijoki H, Moilanen L, Tuomilehto J, Keinänen-Kiukaanniemi S, Uusitupa M. Do statins interfere with lifestyle intervention in the prevention of diabetes in primary healthcare? One-year follow-up of the FIN-D2D project. BMJ Open. 2012 Sep 13;2(5). pii: e001472. doi: 10.1136/bmjopen-2012-001472.
2. Jukema JW, Cannon CP, de Craen AJ, Westendorp RG, Trompet S. The controversies of statin therapy: weighing the evidence. J Am Coll Cardiol. 2012 Sep 4;60(10):875-81.