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Cholesterol-lowering statin drugs fight inflammation and lower the risk of heart disease, but sometimes they also seem to cause diabetes. Is the risk of diabetes worth the benefit of the statin?
It is also true that not every diabetic has blood sugar levels high enough to change ordinary LDL into dangerous, clog-promoting LDL. The glycation process that makes LDL stick to the linings of arteries kicks in when blood sugar levels reach about 155 mg/dl (8.6 mmol/L). This means that some diabetics won't have this problem at all. However, nearly every diabetic has blood glucose levels this high about an hour after eating meals. That is when the damage is done.
Most diabetics have to limit their consumption of carbohydrate to 12 grams or less (the equivalent of a slice of bread, with no other starches or sugars of any kind) at each meal to avoid having blood sugar levels exceeding the 155 mg/dl (8.6 mmol/L) level. Few diabetics are that disciplined. Moreover, many pre-diabetics also have blood sugar levels this high after meals and don't even know it. They are actually increasing their risk of heart disease when they take statins, and they and their doctors never know.
Who Are the People Who Benefit from Statins?
If statin drugs lower one risk factor for heart disease and raise another, can there be any real benefit in taking them? Statin medications, it turns out, do not just lower cholesterol. They also lower inflammation. Inflammation is also a risk factor for heart attack. When inflammation levels are high, it can make sense to take a statin medication, although not because it lowers cholesterol, because it lowers inflammation.
How do you know you have a problem with inflammation? Self-help gurus have long checklists for self-diagnosis of an inflammatory state, but the best way to find out whether inflammation is a problem for you is to have a blood test to measure C-reactive protein. This marker
is a protein. It is one a group of proteins known as "acute phase reactants" that indicate how much inflammation is occurring throughout the body.
A little inflammation, of course, is a good thing. Inflammation activates the immune system. Too much inflammation, however, causes, among other things, blood vessels to constrict. If a blood clot forms, it is more likely to get "caught" in a clogged artery and cause a heart attack or stroke. Lowering inflammation lowers the risk of heart attack or stroke, but not specifically because of changes in LDL cholesterol.
If you don't have elevated C-reactive protein, and you're already diabetic, then statins are of questionable benefit. A study called the Cholesterol Treatment Trialists' (CTT) meta-analysis found that diabetics who take statins are about 14 percent less likely to have heart attacks than those who don't, but they are up to 1 percent more likely to die anyway.
What's The Bottom Line On Statin Drugs And Diabetes?
In the United States, your doctor may drop you as a patient if you refuse to take (or you tell your doctor that you refuse to take) statin drugs. Many doctors are just that convinced that statins are practically like vitamins. What you need to do is to:
- Find out if you are one of the people who really needs statin drugs, whether you have elevated C-reactive protein. If your CRP is high, then take statins.
- Do blood sugar testing after meals whether you have diabetes or just pre-diabetes. If your blood sugars are getting too high, then you have to change the amount of carbohydrate you eat to avoid creating the dangerous sticky LDL cholesterol. It isn't enough just to test your blood sugar levels first thing in the morning. You need to measure them after meals, when they are most likely to be problematic.
- Remember that the risk of heart disease in diabetes is progressive. The longer you have had diabetes, the more likely you are to have heart trouble. Statin drugs aren't as harmful at first, but if you have been diabetic for 10 years or longer you need to be especially careful to keep your blood sugar levels under control, for the sake of your heart.
- Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women's Health Initiative. Annie L. Culver et al. Arch Intern Med. 2012.172(2):144-152. doi:10.1001/archinternmed.2011.625.
- Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy: A Meta-analysis David Preiss et al. JAMA. 2011. 305(24):2556-2564. doi: 10.1001/jama.2011.860.
- Photo courtesy of shaorang via Flickr: www.flickr.com/photos/shaorang/72946504
- Photo courtesy of Agência CNT de Notícias via Flickr: www.flickr.com/photos/agenciacnt/7261720454
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