Statins: Beneficial or Adverse for Glucose Metabolism

Abstract

Large-scale clinical trials have established that statin use for lowering blood cholesterol is beneficial in reducing atherosclerotic cardiovascular diseases in different populations. However, the general reputation of statins seems to be clouded by a potential adverse effect of a class of statins on glucose metabolism. This paper reviewed clinical data of statins regarding the effects on diabetes mellitus and glucose metabolism. At least five randomized controlled studies, primarily investigating the protective effect of statins on the risk of cardiovascular diseases, have addressed the effect of statins on glucose metabolism in Western countries. One study showed that pravastatin (40 mg/day) was protective against the development of diabetes mellitus. Two studies of atorvastatin (10 mg/day) and one study of simvastatin (40 mg/day) showed no measurable effect of these regimens on the risk of diabetes mellitus or the clinical course of diabetes mellitus. One study of atorvastatin (80 mg/day) versus pravastatin (40 mg/day) suggested a deterioration of glucose metabolism associated with a high dose of atorvastatin. In Japan, a few case reports have noted a potential adverse effect of atorvastatin on glycemic control in patients with diabetes mellitus; however, seven clinical trials have showed no such effect of atorvastatin although these studies were relatively small in size and short in follow-up. Only one of the two observational studies suggested a possible adverse effect of atorvastatin on glycemic control. Evidence is extremely limited regarding atorvastatin use and deterioration in glycemic control, and further studies are needed to draw a conclusion on this issue. J Atheroscler

Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study

“…[1][2][3] Secondary diabetes outcomes in large cardiovascular statin trials of individuals without diabetes suggest that statin use can slightly raise the risk of developing diabetes, a fi nding we also confi rmed in this study with an eff ect size similar to those of randomised controlled trials. 6,7 Since worsening glycaemia is associated with microvascular disease, 18 individuals taking a statin after a diagnosis of diabetes might therefore be at increased risk of developing microvascular disease compared with those not taking a statin.…”

“…However, fi ndings of some studies have shown that statin treatment might alter glucose metabolism, resulting in increased levels of glucose [1][2][3] and an increased risk for diabetes in individuals with one or more major risk factors for the disorder. [4][5][6][7] Nevertheless, whether statin use aff ects the development of microvascular disease in individuals with diabetes is presently unknown.…”

Influence of Pitavastatin on Glucose Tolerance in Patients with Type 2 Diabetes Mellitus

“…Sasaki et al have comprehensively reviewed the adverse effect of statins on glucose metabolism 7) . There are only a few relevant clinical trials.…”

Statin Use, Diabetes Incidence and Overall Mortality in Normoglycemic and Impaired Fasting Glucose Patients

“…2,10,27,29 In any event, the underlying mechanism explaining this deleterious effect is unclear, although it has been postulated that statin therapy may interfere with normal glucose metabolism and exacerbate glucose intolerance. 30,31 Statins are recommended for the management of hypercholesterolemia in the primary and secondary prevention of cardiovascular events in patients at risk. 10,[32][33][34][35] Given that diabetes has been considered a cardiovascular disease (CVD) risk equivalent, 36 the use of statins is strongly recommended in patients with diabetes or those at high risk of developing diabetes, including those with metabolic syndrome or prediabetes, 33 in whom CVD is highly prevalent and a common cause of death 19,37,38 ; statins have been shown to prevent cardiovascular events and reduce mortality in this population.…”