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The Statin Debate

In recent years, the widespread use of statins for lowering cholesterol production levels in the liver has been questioned by a number of clinical studies.

Statins serve as a class of drugs that are routinely prescribed to fight atherosclerosis, a condition that may further lead to cardiovascular disease and adverse events. 

A meta-analysis of 13 clinical trials spanning 1994 – 2009, with a total of over 91,000 participants, concluded that statin use is associated with a 9% increased risk of developing type 2 diabetes. 

The risk was deemed to be relatively low and outweighed by the benefits of statin therapy in preventing cardiovascular events like heart attacks and strokes. 

Other research has aimed at clarifying the conditions for the increased risk, as well as concentrated on other previously unobserved effects of statins on the body.

A large study conducted in Ontario, Canada analyzed medical data from 1.5 million residents aged 66 and older.  Various statins were compared with pravastatin.

The risks of diabetes onset were found to be as follows: atorvastatin (20% higher than pravastatin), rosuvastatin (+18%), simvastatin (+10%), fluvastatin (-5%), and lovastatin (-1%).

The number of adverse events decreased from atorvastatin to lovastatin in a similar fashion.

The results indicate that pravastatin, fluvastatin, and lovastatin may represent a safer option for patients with higher risk factors for diabetes: chiefly obesity and high blood sugar. 

Another team at Rochester Methodist Hospital found that post-menopausal women are at an increased risk of new-onset diabetes from the whole class of statins, regardless of the particular type.

Statins were also linked to a high risk of cataracts, an age-related condition where the lens of the eye becomes cloudy, often leading to vision loss. 

The research conducted with 46,000 participants showed a 27% increased risk of cataracts in statin users over non-users.

Conversely, studies with statins have also shown positive effects on the body.  One such benefit is the reduction of gum inflammation in patients with cardiovascular disease. 

A high dose (80mg) of atorvastatin is significantly effective at reducing signs of periodontal disease after 4 weeks, researchers at Harvard Medical School report. 

The coexistence of atherosclerosis and chronic gum inflammation may point to the importance of oral hygiene in reducing artery inflammation. 

However, more studies on this topic are necessary to examine the mechanisms of drug action.

Despite mounting evidence for the slight diabetes risk that accompanies statin use, Harvard researchers advise that the benefits of cardiovascular disease outweigh these risks. 

In a large five-year clinical trial, for every 54 cases of diabetes caused by statin use, 134 cardiovascular events like strokes and heart attacks were prevented. 

Although patients with diabetes risk factors exhibited a 28% higher chance of progressing to the disease, it was counterbalanced by the 39% lower chance of cardiovascular disease progression and 17% less death risk. 

The latter two risks were lowered to 52% and 22% in patients without the risk factors of diabetes. 

The medical community urges patients not to abandon their statin regimens, as the drugs are still very efficient at preventing heart disease and mortality.

Culver, A.L., Ockene, I.S., Balasubramanian, R., Olendzki, B.C., Sepavich, D.M., Wactawski-Wende, J., Manson, J.E., Ziao, Y., Liu, S., Merriam, P.A., Rahilly-Tierny, C., Thomas, F., Berger, J.S., Ockene, J.K., Curb, J.D., & Ma, Y. “Statin use  and risk of diabetes mellitus in postmenopausal women in the women’s health initiative.” Archives of Internal Medicine 172(2): 144-152. 2012.
Huupponen, R., & Viikari, J. “Statins and the risk of developing diabetes.” BMJ 346:f3156.  May 23, 2013.
Leuschen, J., Mortensen, E.M., Frei, C.R., Mansi, E.A., Panday, V., & Mansi, I.  “Association of statin use with cataracts: A propensity score-matched analysis.” JAMA Ophthalmology. DOI:10.1001/jamaophthalmol.2013.4575. September 19, 2013. 
Ridker, P.M., Pradhan, A., MacFadyen, J.G., Libby, P., & Glynn, R.J. “Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial.” The Lancet. DOI: 10.1016/S0140- 6736(12)61190-8.  2012.
Sattar, N., Preiss, D., Murray, H.M., Welsh, P., Buckley, B.M., de Craen, A.J.M., Seshasai, S.R.K., McMurray, J.J., Freeman, D.J., Jukema, J.W., Macfarlane, P.W., Packard, C.J., Stott, D.J., Westendorp, R.G., Shepherd, J., Davis, B.R.,   Pressel, S.L., Marchioli, R., Marfisi, R.M., Maggioni, A.P., Tavazzi, L., Tognoni, G., Kjekshus, J., Pedersen, T.R., Cook, T.J., Gotto, A.M., Clearfield, M.B., Downs, J.R., Nakamura, H., Ohashi, Y., Mizuno, K., Ray, K.K., & Ford, I. “Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials.” The Lancet 375(9716): 735-742.  February 2010.
Subramarnian, S., Emami, H., Vucic, E. et al.  “High dose atorvastatin reduces periodontal inflammation: A novel pleiotropic effect of statins.” Journal of the American College of Cardiology. DOI:10.1016/j.jacc.2013.08.1627.  September, 2013.
 

Written by Julia Yusupova

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