Controversies About Statins

DrEdwadTaubmanThe recent joint recommendations of the American College of Cardiology, the NIH, and the American Heart Association has generated a number of controversies particularly about the expanded role for the statin class of medications in lowering the risk of heart attack, stroke, and sudden death.   Some of the controversies include:

  • Do statins increase one’s risk of developing diabetes? – itself a potent cardiovascular risk factor
  • Do statins help prevent cancer or just the opposite?
  • Once put on statins should the dose of the statin be adjusted up or down to reach a certain goal and what should that goal be?
  • Should women take statins?
  • By encouraging our patients to take statins do we collectively lose sight of the need to exercise and lose weight?

In regards to statins causing diabetes the joint working group reviewed a number of articles that suggested that there is some preliminary evidence that statins might for unknown reasons increase a person’s risk of developing diabetes.  So what might that risk be?  The group cited a preliminary statistic of .1 to .3 new cases of diabetes per year for every 100 people taking the medication.  The lower number was for weaker statins and the higher number for more potent ones.  So to simplify, let’s use a number of .2  If 100 people took statin for ten years then there might be 2 more cases of diabetes than might otherwise have been expected and similarly if 100 people took statins for twenty years there might be an additional 4 cases of diabetes than would otherwise have been expected.  Put another way – if twenty years ago a 50 year old was started on statins then today at age 70 by my calculation he or she might incur  a 4%  additional risk of having diabetes than would otherwise have been expected.  To keep that in perspective the CDC in its 2011 National Diabetes Fact Sheet stated that  almost 27% of Americans over the age of 65 presently have diabetes.  What is not clear is if diabetes that may develop on statins will cause the same degree of diabetic complications as non statin related diabetes.  One could argue that since statins clearly reduce cardiovascular complications in people who are already diabetics that those who develop diabetes while on statins might be expected to have less complications.  In fact the working group recommended that all diabetes be on statins, regardless of their cholesterol levels.  After reviewing all the presently available data the working group felt that at least when it comes to concerns about diabetes that the pros of statins greatly outweighed the potential cons.  Clearly the researchers will be closely watching this issue in the years to come.   What do you think?

Next week statins and cancer.

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