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The Villages
Sunday, April 14, 2024

Everyone who takes statins should get their blood sugar checked

Dr. Gabe Mirkin

Statins may raise your blood sugar levels, but your doctor is still likely to recommended them if you have risk factors for heart attacks or strokes. Reviews of many studies show that statins can raise blood sugar levels, which increases risk for diabetes and cataracts, but they are so effective in helping to lower the bad LDL cholesterol and to prevent heart attacks that doctors should still prescribe them (Cleveland Clin J of Med, January 2023;90 (1):53-62). However, blood sugar levels should be checked regularly in all people who take statins, and these people should follow a plant-based diet that can help to control blood sugar levels:
• avoid mammal meat, sugar-added foods and fried foods
• restrict refined carbohydrates (foods made from flour)
• eat lots of vegetables, whole grains, beans, seeds and nuts
This diet will also help to lower cholesterol and prevent heart attacks.

The Studies
An extensive review of the world’s literature found that statins are associated with a slight increase in insulin-resistant diabetes (Curr Opin Lipidol, June 2015;26(3):228-35), and that high-intensity statins (atorvastatin 80 mg and rosuvastatin 20 mg) are associated with a higher excess risk of diabetes than moderate-intensity statins (atorvastatin 10 mg, simvastatin 20-40 mg, or pravastatin 40 mg). Statins may increase diabetes risk by increasing body fat, liver fat and insulin resistance, and by impairing insulin secretion (Curr Atheroscler Rep, Apr 30, 2019;21(6):23; J Clin Endocrinol Metab, 2023;108(23):385-396; Arterioscl Thromb Vasc Biol, 2021;41:2786-2797). One out of every 100 people who take statins for five years has their blood sugar levels raised enough to become diabetic, which increases their chances of suffering a heart attack or stroke by ten times (Clinical Endocrinology and Metabolism, April 14, 2023;37(3):101749). In 2016, a study found that one extra case of diabetes occurred for every 10 major heart attacks or strokes that were prevented (Lancet, 2016;388:2532-2561).

Classification of Statins
Statins are classified as strong, moderate and weak reducers of cholesterol. Rosuvastatin is classified as a stronger reducer of cholesterol than most other statins. Rosuvastatin reduced total cholesterol 4.7 percent more than atorvastatin, 9 to 12.5 percent more than simvastatin, and 18.7 percent more than pravastatin and lovastatin. Fluvastatin is considered even weaker (Baylor University Medical Center Proceedings, 2000;13:139-43). Atorvastatin is also considered to be a strong cholesterol lowerer. In adults who already have serious heart disease, rosuvastatin and atorvastatin are equally effective in preventing heart attacks, strokes and heart revascularization surgery. Rosuvastatin was associated with lower LDL cholesterol levels but a higher risk of new onset type II diabetes requiring anti-diabetic medicines and cataract surgery, compared with atorvastatin (BMJ, Oct 18, 2023;383:e075837). Unfortunately, the stronger statins that lower cholesterol the most are also the ones that are most likely to raise blood sugar levels. Several trials found that moderate-intensity statins increase insulin-resistant diabetes by about 11 percent and high-intensity statins increase insulin resistance by more than 20 percent. In 2015, a review of 15 placebo-controlled studies found that statins raised diabetes risk by 11 percent with the SPARCL trial, so higher intensity statins had a higher risk for developing diabetes (Lancet, 2015;385:351-361).

My Recommendations
Statins have been shown to help prevent heart attacks and strokes in people who have heart attack risk factors, but on occasion, they can raise blood sugar enough to increase risk for diabetes and cataracts. Everyone who takes statins should get their blood sugar checked periodically, and they should follow a diet that helps to control blood sugar and to prevent diabetes, heart attacks, strokes and dementia.

Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com

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