More than 200 million people in the world take statins every day as medication for the problems caused by chronic atherosclerosis in the arteries and consequently to avoid heart attacks and strokes. The statin market is estimated to have a turnover in excess of $15 billion and all indications are that this number will increase as more and more young people begin to include this drug in their routine as a counterweight to the fatty and stressful lifestyle of our times. . However, the results of newer scientific research are beginning to cast doubt not on the effectiveness of statins in the "war" against LDL ("bad" cholesterol), but for two other reasons: First, because statins seem to somehow create the conditions for developing Type 2 diabetes. And secondly, because neutralizing LDL may not be the answer to cardiovascular disease, as some researchers argue.
In the US, about 83% of people between the ages of 40 and 59 who take cholesterol-lowering drugs are taking statins. Although statins are effective in preventing cardiovascular disease, some trials have suggested that they may increase the risk of diabetes.
In research published in the journal Diabetes Metabolism Research and Reviews, the findings suggest that statins may actually increase the risk for this chronic condition. Study leader Victoria Zigmont, assistant professor of public health and director of the Laboratory of Epidemiology at the University of Mississippi, and her team reviewed health records from 4.683 men and women who did not have diabetes at the start of the study but were at risk of heart disease . Of the participants, 755 people (16%) were taking prescription statins at the start of the study. Zigmont's team took into account factors such as gender, age, ethnicity, education, cholesterol and triglyceride levels, body mass index (BMI), waist circumference and how often the participants visited their doctors.
The analysis showed that people taking statins were more than twice as likely to be diagnosed with diabetes than those not taking the drug. In addition, people who took statins for more than 2 years were more than three times more likely to develop diabetes. In addition, the analysis revealed that those taking statins had a 6,5% higher risk of high blood sugar.
"The fact that increased duration of statin use was associated with an increased risk of diabetes—something we call a dose-dependent relationship—leads us to believe that this is likely a causal relationship," explains Dr. Zigmont.
However, although the study sample was large (nearly 5.000 people), the researchers were not able to take into account other medications the participants may have been taking, nor were they able to account for any daily health habits such as smoking or alcohol use. In addition, the researchers did not know whether the participants had prediabetes at the start of the study or not. Therefore, statin use was not examined in combination with all other factors that may lead to the onset of diabetes.
Another study published in the NEJM (New England Journal of Medicine – 2008) found that older, healthy adults given 20 milligrams of rosuvastatin daily for two years had a greater risk of developing diabetes than those given a placebo. medicine.
Dr. Jill Crandall, professor of medicine at the Albert Einstein College of Medicine notes that "there was a feeling that statins might reduce the risk of diabetes, but in the end, we found something completely different." Dr. Jill Crandall investigates the link between statins and diabetes risk, noting that the risk is moderate, but higher, for those who are prediabetic when they start taking statins to lower their blood cholesterol levels.
Several other analyzes have confirmed the link between statins and diabetes risk, but the causes are still a mystery. So far, animal studies and human clinical trials have suggested that statins may make cells more resistant to insulin, a hormone that helps regulate blood glucose levels. When this happens, blood sugar levels can rise so high that the risk of type 2 diabetes increases.
The LDL
Alongside the issue of statins, the LDL debate is ongoing. In relation to HDL (good) cholesterol, LDL has the role of "bad" as can be seen from the nickname given to it to distinguish the two types (bad cholesterol). Regarding its usefulness in the human body, there are researchers who argue that the campaign to eliminate it is due to the powerful marketing of pharmaceutical companies aiming for the highest possible drug sales. What really matters?
In an earlier publication by Harvard Health Publishing, it is stated that: in the right amount, LDL is actually essential. It carries insoluble cholesterol through the bloodstream to nerves and other tissues that need it. Conversely, LDL becomes "bad" when there is too much circulating, due to a diet high in saturated fat, a diet high in calories, or a genetic problem. Some of the excess LDL ends up in the inner lining of the arteries, where it undergoes a chemical transformation known as oxidation. White blood cells called macrophages perceive oxidized LDL as foreign or harmful and engulf it. As macrophages fill up with oxidized LDL and die, they send chemical signals that cause inflammation in the artery wall. This constant, low-grade inflammation contributes to artery damage.
In the same direction is the study of Steve Riechman, associate professor of kinesiology at the School of Education & Human Development at the University of Texas, which was published in the Journal of Gerontology. He and his team, professors from the Universities of Pittsburgh, the University of Kent, the Johns Hopkins Weight Management Center and the Northern Ontario School of Medicine, looked at 52 adults aged 60 to 69 who were generally in good health but were not physically active . The study showed that after fairly intense workouts, the participants who had gained the most muscle mass also had the highest levels of LDL (bad) cholesterol. As says Dr. Riechman: “It shows that the human body needs a certain amount of LDL to gain more muscle mass. There is no doubt that the body needs both types of cholesterol (LDL and HDL). It is not possible to remove all of the 'bad' cholesterol from the body without causing serious problems."
According to research LDL acts as a warning sign that something is wrong and gives the body warning signs. "People often say they want to get rid of all the bad (LDL) cholesterol, but in that case they would die. Everyone needs a certain amount of both LDL and HDL in their body. We need to change the idea that LDL is always the source of evil," emphasizes the professor.
American Heart Association
Following this development, the American Heart Association issued a scientific statement on the safety of statins, concluding that the benefits of reducing cardiovascular risk far outweigh the risks of new-onset diabetes.
He notes that the risk of developing diabetes in those taking statins "is largely limited to patients with many pre-existing risk factors for diabetes mellitus. The absolute risk of statin-induced diabetes mellitus in large trials was ≈0,2% per year. The magnitude of any effect on routine clinical practice will depend on the baseline risk of diabetes mellitus in the patient population. Furthermore, in patients with diabetes mellitus, the mean increase in glycated hemoglobin (HbA1c) upon initiation of statin therapy is small and therefore usually of limited clinical significance."
Connie B. Newman, an endocrinologist and assistant professor of medicine at New York University School of Medicine, who chaired the expert panel that drafted the statement, points out that “Statins are adjuncts to diet, and prescribers should also recommend to the patient and change of habits. They are not meant to be prescribed without discussion of the importance of a healthy lifestyle."
The relevant statement of the American Heart Association concludes that "Treatment with statins significantly reduces cardiovascular events in people with and without diabetes mellitus, and in the latter case, several cardiovascular events are prevented for each new diagnosis of diabetes mellitus. Furthermore, when considering the increase in newly diagnosed diabetes mellitus, it is important to note that this represents a much less dramatic and life-threatening event than the occurrence of myocardial infarction, stroke or cardiovascular death."
In a randomized (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), 27% were found to be at increased risk of diabetes, but it occurred in only 0,6%. Savitha Subramanian, an associate professor of medicine in the Department of Metabolism, Endocrinology and Nutrition at the University of Washington, argues that the ratio is small: "Based on the data in the literature, if 1.000 people are treated with statins each year, only one person may develop diabetes ».
In the academic journal The Lancet (2016) it is pointed out that "exaggerated claims about the rates of side effects with statin therapy may be responsible for reduced consumption by people at increased risk of cardiovascular events". At the same time in 2012, the FDA (Food and Drug Administration) instructed that statin labels list possible side effects such as confusion, memory loss, liver problems, blood sugar spikes, muscle weakness and interactions with certain other drugs, which scares the patients and acts as a deterrent.
Dr. Marilyn Tan, associate professor of medicine-endocrinology at Stanford University School of Medicine, is reassuring: "An otherwise healthy, younger person is at much lower risk of developing diabetes than someone who is older and has other risk factors."
Any link between statins and diabetes should not reduce the use of statins when they are needed, but instead promote improving patients' lifestyles, which benefits both cardiovascular disease and diabetes risks, according to Dr. Newman. Losing weight, improving nutrition and exercising regularly are all steps that patients should take to have a better quality of life in any case.
Source: protothema.gr