August 10, 2012
Debate Looms Over Statin Use: Good For The Heart, Bad For Blood Sugar
Lawrence LeBlond for redOrbit.com - Your Universe Online
Millions of people take statins to reduce the risk of stroke or heart attack. Yet, a debate looms whether the benefit of the widely-used drugs outweigh the risk associated with the onset of type 2 diabetes. A report in The Lancet states that the benefits are worth the risk to those who are already prone to the blood sugar disease; while other research warns that in people who are at a higher risk of type 2 diabetes, taking statins can increase the chances of developing the disease by 28 percent.
Conventional medical wisdom states that statins are a good ℠cure-all´ for heart disease, but making dietary changes and being more active is more effective, say scientists. While statins are effective for treatment of heart problems, especially in those who have had a heart attack or stroke, Professor Kausik Ray, of St George's Healthcare Trust in London, said this effectiveness only accounts for a small number of patients who are actually prescribed statins. The majority of statins are given to people who are only at risk of the disease.
And Ray said it is difficult to predict who is at risk. He said that people with no family history of heart disease and others that are deemed low risk, “other approaches should be used, like eating a good diet full of fish, lean meat, vegetables and low in saturated fat.”
And in healthy people not at risk of diabetes, statins have no effect. In the UK, doctors consider statins only for people whose chances of having a heart attack over the next decade are 20 percent or greater.
A new study, led by Professor Paul Ridker, of Brigham and Women's Hospital, Boston, analyzed data gathered during the JUPITER trial, the first controlled study to report that taking statins results in an increased risk of developing diabetes.
“When we focus only on the risk (of diabetes) we may be doing a disservice to our patients," said Ridker. “As it turns out for this data, the hazard of being on a statin is limited almost entirely to those well on their way to getting diabetes.”
The US Food and Drug Administration (FDA) forced statin makers to add warning labels to their products saying they raise blood sugar levels after several previous studies had shown that some people are at a slightly higher risk of developing diabetes when on statins (9.9 percent, compared to 6.4 percent for those not on statins).
“We're concerned that many diabetics stopped taking statins because of those warnings,” says Ridker.
Ridker´s study analyzed results from a study of 17,000 patients in 2008. Ridker was the principal investigator for that study, which lead many physicians to prescribe statins for preventive uses in people who don't have heart disease.
“Our results show that in participants with and without diabetes risk, the absolute benefits of statin therapy are greater than the hazards of developing diabetes,” noted Ridker. “We believe that most physicians and patients would regard heart attack, stroke and death to be more severe outcomes than the onset of diabetes, and so we hope that these results ease concern about the risks associated with statin therapy when these drugs are appropriately prescribed — in conjunction with improved diet, exercise and smoking cessation — to reduce patients' risk of cardiovascular disease.”
Some health experts do not agree with Ridker´s findings, and think too many physicians over-prescribe statins. About one in 4 Americans over the age of 45 take statins, according to the National Center for Health Statistics.
Prescribing statins to people who don´t have heart disease “is still a big issue, despite what this paper says,” Eric Topol, director of the Scripps Translational Science Institute in San Diego, told USA Today´s Janice Lloyd. “Per 100 people you have two heart attacks less and one increase in diabetes. They're trying to say it benefits more than it harms. But the benefit is so small.”
He said the patients that he sees are not aware of the risks associated with taking statins. “The patient doesn't know this might make their protection for heart attack marginally better but it also could backfire by inducing diabetes.”
Justin Smith, director of a documentary entitled “Statin-Nation,” due out in September, said the benefits of statins are routinely exaggerated and that the pharmaceutical industry is partly to blame.
“Creating a drug is a costly and lengthy process so they are encouraging more patients to take existing drugs,” Smith told Mail Online.
Smith, an ex-personal trainer and author of the book “$29 Billion Reasons to Lie About Cholesterol,” published in 2009, said he made the crowd-funded documentary because he believes doctors are being provided with too much information that favors the drug industry.
Smith´s remarks were contested by Professor Peter Weissberg, from the British Heart Foundation, saying: “The most commonly used statins are off patent, which means the drug companies no longer have any financial incentive in expanding the market.”
“It is the medical community who is pushing for wider use of statins since they are convinced by the evidence this will reduce heart attacks and strokes in the future,” Weissberg told Mail Online.
Smith pointed out a 2008 study (Coronary Heart Disease Statistics) which found the heart disease rate did not decline between 1994 and 2006 in men aged 65 to 94 yet high cholesterol levels dropped by 40 percent.
“I hope that the film will prompt more people to ask their doctor questions like: if I take this cholesterol medication, how much longer might I live?” remarked Smith. “This question is important because most people will not receive life extension from statins.”
He added that negative side-effects of statins were not given enough prominence.
Maureen Talbot, Senior Cardiac Nurse at the British Heart Foundation, also disagreed with Smith´s views.
“Statins are now a very important part of the lives of millions of people and play a vital role in both lowering cholesterol and helping prevent heart attacks,” she said. “Their importance shouldn´t be underestimated and the potential risk of side effects are outweighed by the proven benefits. The use of statins is the main reason why fewer people have high cholesterol levels now compared to 20 years ago.”
“Your body will always make cholesterol so if you stop taking a statin it´s likely your cholesterol levels will rise. So, if you´re prescribed a statin make sure you take it every day because they´re most beneficial when you take them on a long-term basis. If you develop side effects see your GP as the medicine or dose can be changed.”
“It´s worth remembering though that you may be able to head off the prospect of being prescribed statins by eating a healthy balanced diet, keeping physically active and maintaining a healthy weight and body shape,” expressed Talbot.
“The 'take home' for clinicians is to know what the risk factors [for diabetes] are,” Larry Deeb, former president of medicine and science for the American Diabetes Association, told USA Today. “But very often if you throw diabetes into the mix, it's cardiovascular disease that will kill them.”
By no means, though, should everyone with diabetes be on statins, Deeb warned -- unless they have other risk factors for heart disease.