An elderly patient who had been diagnosed with cardiovascular disease approached me and said, "Dr. Zhang, I don't want to take statins! I saw on TV that statins can cause diabetes, and I don't want to get diabetes!"

If it's true what this patient says, do people still need their statin lipid-lowering drugs?

As we all know, statin lipid-lowering drugs have gradually become the cornerstone class of drugs for the treatment of cardiovascular and cerebrovascular diseases since the famous 4S trial in 1994, and it can be said that its status is not at all inferior to that of aspirin. Nowadays, in our society, the number of people who take statin is not less than those who take aspirin at all. The most common side effects of taking statin are liver function damage and muscle damage, in fact, in addition to this, statin can also lead to diabetes, which is also attracting more and more people's attention. It's because of this point that the opening scene came about.

The first study to report that statins can cause diabetes was the JUPITER study in 2008. In the years since, several studies have shown that long-term oral use of statins can lead to an increased chance of diabetes.

Since this is the case, the next concern was whether statins could also be used to treat cardiovascular diseases such as coronary heart disease, since statins can lead to the development of diabetes. Eventually, people have found after more research that almost all studies show that although statin lipid-lowering drugs may increase the risk of blood sugar abnormalities, their therapeutic effects on cardiovascular diseases are unquestionable. Therefore, the mainstream medical profession has always believed that the benefits that statins bring to patients with cardiovascular and cerebrovascular diseases far outweigh the disadvantages brought about by their unfavorable effects on blood glucose. Therefore, the mainstream medical profession still suggests that the majority of patients with cardiovascular and cerebrovascular diseases should usually take statin lipid-lowering drugs.

Even so, many people are still very concerned about the effect of statin on human blood sugar. Dr. Zhang here to explain to you two sentences, if you take statin afraid of diabetes, my suggestion is that you can pay attention to increase exercise, diet control, and at the same time pay attention to monitoring blood glucose, in fact, most people can still control the blood glucose.

In short, if you are a patient with cardiovascular disease, statin lipid-lowering drugs should be taken or should be taken, never choke on it, don't you think?

Statins are currently the cornerstone of the treatment and prevention of atherosclerotic cardiovascular events and are recommended by all major cardiovascular guidelines. Common adverse effects of statins are elevated liver enzymes and muscle damage. In addition to these two side effects, statins can cause elevated blood sugar.

On February 28, 2012, the U.S. Food and Drug Administration (FDA) issued an announcement warning that statins can increase the risk of new-onset diabetes and worsen blood sugar control. It seems that statins are not an empty threat to diabetes.

High risk of developing diabetes in people at high risk of developing diabetes

Meta-analysis of a randomized controlled study showed that statin therapy increased the relative risk of new-onset diabetes by 9%. Individuals with risk factors for new-onset diabetes were at increased risk, for example:

1 Metabolic syndrome

2 Pre-existing impaired fasting glucose (>5.6 mmol / L) on statin therapy

3 Severe obesity (BMI ≥ 30)

4 Elevated glycated hemoglobin (HbA1c >6%)

5 Elevated fasting triglyceride level (>1.7 mmol/L)

6 History of hypertension.

Mechanisms of occurrence

The triggering of diabetes by statins may be related to their effect on glucose metabolism, an effect that may affect both nondiabetic and diabetic patients, and the exact mechanism is unclear.

A Mendelian randomization study found that genetically reduced HMG CoA reductase activity was associated with a higher risk of type 2 diabetes, i.e., the risk of statin-induced elevation of blood glucose appears to be a result of the inhibitory effect of such drugs on HMG CoA reductase. Thus, the therapeutic effect of statins and this elevated glycemic side effect go hand in hand.

factor

The study found that the risk of diabetes was close for hydrophilic and lipophilic statins, and there were no clear differences between each statin. The risk of new-onset diabetes was elevated with intensive statin therapy compared with moderate-intensity statin therapy.

Expert Advice:

Although statin therapy slightly increases the risk of new-onset diabetes, the cardiovascular benefits of statin therapy far outweigh the risk of new-onset diabetes.

1 It's a good idea to test your blood sugar levels before using statins.

2 For patients with myocardial infarction and stroke, close monitoring of glycemic indices is required during intensive statin therapy.

3 For patients at low risk or with diabetic risk factors, a moderate-intensity statin may be considered.

4 For patients who still cannot control their lipids well enough to reach the target level with the application of moderate-intensity statin, it is recommended to combine with other classes of lipid-modulating drugs, such as ezetimibe.

For patients with very high risk or high risk of cardiovascular disease, if accompanied by high blood fat, need to take long-term statin drugs, can effectively lower blood fat, stabilize plaque, slow down the process of atherosclerosis, reduce the risk of cardiovascular disease. However, during the long-term use of statins, attention should also be paid to the side effects that may be caused by taking the drug.

For long-term use of statin drugs may cause abnormal glucose tolerance and new-onset diabetes, as early as 2012 and 2013, the U.S. FDA and China's State Food and Drug Administration have issued a bulletin warning of long-term use of statin drugs may cause diabetes risk issues, but is not this risk, statin drugs can not be eaten? Today to explain in detail for everyone -

Does taking statins always cause diabetes?

Of course not, for the atorvastatin talked about in the title, there are indeed several large clinical studies that show that long-term use of atorvastatin, relative to the placebo group, atorvastatin caused a significant increase in the proportion of new-onset diabetes, but even so, atorvastatin triggered diabetes is not a high percentage, generally high-intensity therapeutic dosage, the proportion of triggering blood sugar abnormalities in about 4 to 5%, in addition to the In addition to atorvastatin, other statins that may cause new-onset diabetes are simvastatin, and resuvastatin. Compared to these three statins, pravastatin, lovastatin, and fluvastatin have insufficient clinical data to cause diabetes, and the chances of causing diabetes are relatively low.

Why long-term use of atorvastatin may cause diabetes

There is no conclusive evidence as to the exact cause of statins causing abnormal glucose metabolism and the development of new-onset diabetes, and the two main reasons currently hypothesized by the scientific community are:

1. Long-term use of statins leads to abnormal regulation of intracellular cholesterol, which in turn affects insulin sensitivity, causes insulin resistance and hinders insulin secretion, leading to abnormalities in glucose tolerance and the development of diabetes mellitus;

2. Statins, with their adverse effects on mitochondria, are one of the main causes of statin-induced skeletal muscle side effects (muscle pain), which also affect the uptake and utilization of glucose by the skeletal muscles, leading to blood sugar abnormalities and diabetes.

How to Take Care to Prevent Diabetic Side Effects When Taking Statins

1. The effect of statins on blood glucose metabolism is greatly related to the intensity of taking statins. Taking atorvastatin as an example, taking 10mg of atorvastatin per day has no significant effect on blood glucose metabolism, but if you take 80mg of high intensity statin per day, the risk of causing diabetes will increase. Therefore, on the basis of being able to control blood lipids to meet the standard, try to choose the dose of low to medium intensity is the best way to reduce the statin caused by abnormal glucose metabolism.

2. For patients who are already at risk of diabetes, such as those with abnormal glucose tolerance, impaired fasting blood glucose, chronically high triglycerides, and high glycated hemoglobin, even though diabetes has not yet been diagnosed, they should try to take pravastatin, lovastatin, and fluvastatin, as mentioned above, and consider taking ezetimibe instead of increasing the dosage if lipid control is not met.

Taking a statin may cause diabetes, is it better to stop taking it when you have abnormal blood sugar?

Of course not! Several studies and guidelines have pointed out that taking statins can reduce the chances of cardiovascular disease by 25% to 30%. As an example, one study found that for every 255 patients, 4 years of statin therapy effectively reduced 5.4 serious cardiovascular events, while only 1 patient would develop new-onset diabetes, an example of what can be done for theStatins have a low probability of triggering diabetic issues, theThe cardiovascular health benefits of long-term statin use are far more important.

Therefore, drug regulatory authorities in various countries, in their bulletins warning of the potential for statins to cause abnormalities in blood glucose metabolism, do not recommend discontinuing statins due to problems with abnormal blood glucose.

The cardiovascular benefits are large compared to the cardiovascular benefits, and the risk of statins increasing the risk of new-onset diabetes is small, thus eliminating the need to change the current statin regimen.

Regular monitoring of blood glucose, especially in elderly patients where high dose statins are contraindicated (regular medical checkups as prescribed).

Physicians should assess whether patients need statins, and if cardiovascular benefit requires statin medication, it is appropriate to choose a statin that is achievable at routine doses and to monitor blood glucose regularly.

I am a medical doctor, a resident, specializing in the popularization of medical knowledge for the benefit of human health, if you want to know more, please pay attention to me, have questions can be left a message, will respond!

Is it really possible to get diabetes from atorvastatin? What is the basis for this?

Statins are now widely used and need to be taken orally for long periods of time whenever there is atherosclerotic disease. So can atorvastatin really cause diabetes? I will discuss this question below.

1. is it really possible to get diabetes on atorvastatin?

Oral statins have the potential to cause diabetes; on February 28, 2012 the U.S. Food and Drug Administration issued an announcement that statins can increase the risk of diabetes; thusAtorvastatin also increases the risk of diabetes;

2. Why does atorvastatin increase the risk of diabetes?

It is unclear and may be related to statins affecting glucose metabolism;

3. Should I stop taking oral statins?

Oral statins should not be stopped;Because statins can stabilize plaque, lower blood lipids and have anti-inflammatory effects, they can significantly reduce the incidence of myocardial infarction, stroke, etc. caused by all cardiovascular diseases; therefore, their benefits far outweigh their harms;

4. What should I be aware of when taking statins?

• Test your blood sugar before taking it orally;
• Blood glucose should be monitored while taking statins, and the dosage needs to be reduced under the supervision of a doctor if an elevation is detected;
• Patients with a combination of coronary heart disease, myocardial infarction and other cardiovascular diseases need to take statins for a long time even if their blood lipids are at normal levels;
• Take statins as prescribed by your doctor and do not add medications privately;
• Symptoms such as muscle pain and muscle tenderness after taking the medication should be seen promptly;
• Regularly review liver function.

Final Summary: Taking atorvastatin can cause diabetes, as the U.S. Food and Drug Administration has announced.

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Dr. Cardiovascular Wang deals with statins almost daily and is very familiar with atorvastatin!

That's right, not only may atorvastatin cause elevated blood sugar, but atorvastatin has other side effects: abnormal liver function, muscle damage; even headaches, insomnia, depression, indigestion, abdominal pain and diarrhea.

However, our focus is primarily on the three most common points above, and elevated blood sugar, liver abnormalities, and muscle damage.

How do we deal with the side effects of atorvastatin? First we look at blood sugar:

1, atorvastatin, may cause blood sugar abnormalities

However, the increase in blood glucose caused by atorvastatin is essentially insignificant compared to the benefits that atorvastatin provides to patients.

Because statin-induced diabetes, mostly seen in people who are already vulnerable to diabetes future, such as obesity, metabolic syndrome, abnormal glucose tolerance. And there is a relationship with statin overdose; for every case of diabetes caused by long-term statin use, the risk of cardiovascular disease can be simultaneously reduced by 9. 9:1, how to choose, it is clear.

That being said there really is no way to completely eliminate this side effect, but the reason why we still choose statin is because of the benefit it can bring to more patients who need it!

2, the use of atorvastatin is likely to increase transaminases

Elevated aminotransferases are correlated with the dose of the drug, when the aminotransferases are elevated, reduce the dose, the aminotransferases may fall back. When atorvastatin causes elevated transaminases, the dose can be adjusted or the drug can be discontinued in time, and the liver function can basically return to normal. The main thing is to monitor the liver function, especially in the first month.

3, Pulldevelop muscle damage

This is a common side effect of all statins. This side effect is more troublesome and sometimes has serious consequences. During use, when there is muscle soreness and muscle weakness you should stop the drug immediately and go to the hospital to have your serum muscle enzymes checked.

Atorvastatin, like the other latest statins, is also playing an increasingly important role in the prevention of cardiovascular disease together, although statin has :liver, muscle enzymes, blood glucose and other side effects, but this does not affect the statin to bring benefits to a wider range of patients.

All medications are the same, first see if it is necessary to use them, if it is necessary, then we monitor the side effects and there is no need to worry about it, because worrying solves nothing!

We should not be afraid to take atorvastatin for fear of side effects, as all those who take atorvastatin have some indication of this.

We also can't turn a blind eye to the potential side effects of atorvastatin, which require regular rechecks of the lipid panel, blood glucose, muscle enzymes, and liver function!

Statins are known as the cornerstone drugs in the cardiovascular field, which not only lower blood lipids, but also delay plaque growth, stabilize plaque, and prevent thrombosis, and are therefore most commonly used in the prevention and treatment of cardiovascular and cerebrovascular diseases.

Is it really possible to get diabetes on atorvastatin and what is the basis for that?

Of all the statins, atorvastatin is one of the most commonly used and many older people may need to take it for a long time. Rather, the medication is a three-pronged approach, and taking it for a long period of time will inevitably increase the risk of side effects from the medication occurring. Among them, taking atorvastatin for a long period of time has the risk of elevating blood glucose and inducing new onset diabetes, which is of greater concern to many patients.

First, statins do have the potential to raise blood sugar and induce diabetes.

Several studies have now shown that statins increase the risk of developing new-onset diabetes, with 5 years of statin use increasing the risk of developing new-onset diabetes by 28%, as well as significantly higher glycosylated hemoglobin values. In addition, for diabetic patients, statin use has also been associated with elevated glycosylated hemoglobin in patients.

Statistically, 13 studies have found a 9% increased risk of new-onset diabetes with statin treatment . High-dose statin therapy increased the risk of new-onset diabetes by 12% over moderate-dose statin. Studies have shown that statins can affect insulin sensitivity and cellular utilization of blood glucose, and can have a direct effect on the cellular uptake of glucose, which in turn produces insulin resistance. In addition, statins can reduce both intracellular insulin release by inhibiting the direct action of HMG-COA reductase and insulin secretion by decreasing cholesterol synthesis, a series of actions that have the effect of increasing the risk of new-onset diabetes.

Second, the benefits of taking a statin outweigh the risks.

While it is true that taking atorvastatin for a long period of time carries the risk of raising blood sugar and inducing diabetes, it has been shown that this is only a very small number of individual cases. For the vast majority of patients, the benefits of taking atorvastatin long-term outweigh the risks.

For patients who are taking statin for a long period of time, most of them are taking statin for prevention or treatment of cardiovascular diseases, and for these patients, taking statin will surely be obviously beneficial. The results of several studies have confirmed that statin can significantly reduce the risk of cardiovascular and cerebrovascular diseases, and long-term preventive use of statin can reduce the incidence of cerebral infarction by about 40%. Even for diabetics, there can be benefits. Studies have shown that statins reduce the risk of all-cause mortality in diabetics by 7% and the risk of heart attack by 27%, a benefit that far outweighs the effect on blood glucose.

Therefore, for non-diabetic patients, can rest assured that taking statin, pay attention to regular review can be, and for diabetic patients, statin indications should be adhered to take, pay attention to closely monitor blood glucose during the use of medication, if the blood glucose is out of control, worsening of the condition, should be timely medical treatment!

Finally, the do's and don'ts of taking statins.

For patients who take statin for a long time and want to avoid side effects, it is important to take the right medication, to get the right dosage and duration of the medication, etc.

一般来说，他汀副作用发生与剂量明显相关，要求从小剂量开始，以种中等剂量作为长期维持用量，不得擅自增加用药剂量；切忌擅自停药；用药时间与所用他汀种类有关，阿托伐他汀和瑞舒伐他汀可在任何时间服用；注意用药期间 不要吃西柚、橙子等水果，切忌饮酒；注意积极应对出现的 Side effects, 1 month after the initial use of drugs to the doctor to review, if found to have discomfort, timely medical adjustment of the treatment program; to be alert to the risk of combined use of drugs; and finally take statin at the same time to live a healthy life.

I am Pharmacist Wang, dedicated to helping you manage your body by explaining complex and difficult disease knowledge in plain words. Your kudos are my greatest motivation! Also, if you have a family member with statin and diabetes-related troubles, please pass this article on to them!

Atorvastatin is a class of oral lipid-lowering drugs widely used in clinical practice, which is mainly used to lower the level of low-density lipoprotein (LDL) in the blood and reduce cholesterol for the purpose of prevention and treatment of cardiovascular diseases. However, in November 2012, the State Food and Drug Administration (SFDA) issued an Adverse Drug Reaction Bulletin (ADR Bulletin) reminding patients and medical personnel to be alert to the abnormal adverse reactions of blood glucose to statins. In the "Notice of the General Office of the State Food and Drug Administration on Revision of Statin Drug Specifications" (Food and Drug Administration Office of Pharmaceutical and Chemical Management [2013] No. 90), the first of the additions to the [Adverse Reactions] section was: new-onset diabetes, abnormal glucose tolerance, hyperglycemic reactions, deterioration of glycemic control, and elevation of glycosylated hemoglobin levels have been reported in postmarketing surveillance of statin drugs, and some statin drugs have also been associated with hypoglycemic reactions. Hypoglycemic reactions were also reported for some statins.

The State Food and Drug Administration suggests that patients who experience symptoms that may be related to dysglycemia or diabetes, such as excessive drinking, urination, fatigue, and excessive eating, should immediately consult a physician to clarify the cause of the disease and take appropriate management measures.

If a patient already suffers from cardiovascular disease or has high risk factors for cardiovascular disease, he or she must take statins for a long period of time to control lipid levels, and even if there is an adverse effect of elevated blood glucose, the pros and cons should be weighed and the statin should not be discontinued at will. The U.S. Food and Drug Administration (FDA) believes that the benefits of statins for cardiovascular disease are much greater than the risk of new-onset diabetes, and the relationship between the two is 9:1, which should not be given up for patients with cardiovascular disease because of the risk of new-onset diabetes.

References:

[1] State Food and Drug Administration warns against abnormal glycemic adverse reactions to statins and interactions with HIV protease inhibitors. China Pharmacy, 2013 (1) :29-29.

[2] Li P, Meidan. Effects of statins on blood glucose[J]. China Hospital Medication Evaluation and Analysis, 2014, 14(2):102-103.

[3] SUN Jing, CHEN Tielong, CHEN Qilan. Research progress on the effect of statins on diabetes mellitus[J]. China Modern Physician, 2016, 54(26):162-164.

Author：Li Chunyu Unit：Clinical Pharmacy Department, Fengtai Hospital, Beijing, China, Member of Pharmaceutical Affairs Network

Drugs.com authoritative interpretation, unauthorized reproduction, plagiarism will be prosecuted

Not just atorvastatin, but other statins may increase the risk of diabetes.

One meta-analysis comparing statins to diabetes may have added one diabetic to every 250 or so people in the population of patients who used statins over 4 years of follow-up.

There was also a study that showed different statins increased the risk of diabetes differently, with atorvastatin increasing the incidence of diabetes by 22%, resuvastatin by 18%, simvastatin by about 10%, and fluvastatin having little effect.

And statin increases diabetes risk in relation to dose and duration. High-intensity therapy increases diabetes risk even more.

Although statins have an increased risk of diabetes, guidelines suggest that if a patient has cardiovascular disease and has atherosclerosis, the benefits of statin use outweigh the risk of statin-induced diabetes.

So for people who are at high risk of diabetes themselves, if they want to use statin, they should strengthen blood glucose monitoring and actively prevent diabetes from occurring, if they are not at high risk of diabetes themselves, and there are indications to use statin, weighing the pros and cons is possible to use.

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There is such a thing.

This is because clinical summaries of statin use have shown that there is an increase in the number of people taking statins who have elevated blood glucose and new-onset diabetes. This is not only true for atorvastatin, but also for other statin drugs.

So.The possibility of elevated blood glucose and increased risk of new-onset diabetes with statins is a "class effect" of these drugs.All of these medications have effects.

"What is the risk of statins raising blood sugar and increasing diabetes?

Here's what the research says.Treating 255 patients over 4 years would increase the number of new cases of diabetes by 1.

"Why do statins raise blood sugar?

Some studies believe that statin drugs may weaken the body's sensitivity to insulin, and it is also believed that statin drugs affect the role of pancreatic islet cells to secrete insulin. As a result, insulin secretion is reduced and the body is insensitive to insulin, the metabolism of blood glucose and blood lipids is affected, and blood glucose rises.

However, this is not conclusive. Because patients with cardiovascular disease or high-risk groups often have abnormalities in blood glucose and lipid metabolism, they are themselves at high risk for diabetes. Some people may develop diabetes in the future even if they do not take statins. Therefore, it is difficult to determine whether the elevated blood glucose in these patients is due to their own problems or due to statins.

In other words, statin use can cause blood glucose to rise, but the patient's blood glucose rise is not necessarily due to statin use.

Taking "statin" drugs may raise blood sugar, that high blood pressure, coronary heart disease, diabetes patients can still take "statin"?

Of course you can and you will.。

Because taking a "statin" to lower cholesterol is a real benefit to people with cardiovascular disease and diabetes. Studies have confirmed thatTaking a statin to lower LDL-C by 1 mmol/L reduces 5.4 deaths or myocardial infarctions, and reduces strokes and coronary artery stenting or bypass grafting by about the same amount.In this way, the overall cost of taking statins to prevent and treat cardiovascular disease isThe ratio of benefit to risk is 9:1.The benefits far outweigh the risks.

Therefore, although taking "statin" drugs have elevated blood sugar, increase the possibility of new diabetes, cardiovascular disease patients and high-risk groups have to take. Studies have found that among the "statin" drugs, pravastatin and pitavastatin have less effect on raising blood sugar, and patients can choose drugs according to their conditions.