To Your Good Health: Statins Play a Small Role in Diabetes
Dear Dr. Roach: I am concerned about simvastatin possibly causing a rise in my A1C reading indicating a concern about diabetes.
There has never been diabetes in my family. I am a 77-year-old female in good health. I exercise and walk regularly. I do have elevated cholesterol, for which I take 20 mg of simvastatin.
I noticed six months ago that my A1C was 5.7 and there was a little flag next to that number. The doctor explained to me that this indicated possible prediabetes and the number should be watched.
This past month the A1C was 5.8. I have since read that there is a possible connection between statins and diabetes.
My total cholesterol was 203. This reading had gone up from 189. I was taking 10 mg of simvastatin, and it was raised to 20 mg due to this increase. My good cholesterol was 59.
I am far more concerned about becoming diabetic than I am about having a stroke. I have read of so many complications from diabetes in the elderly that I wish to avoid it like the plague.
I exercise and eat well. My BMI is 22. If the statin were to cause diabetes, could it be reversed by stopping the medication?
I want to be able to discuss this with my doctor intelligently when I next see him. — D.P.
Answer: Several studies have confirmed that taking a statin, such as simvastatin, is associated with a higher risk of developing diabetes.
The risk is particularly high in people like yourself, with a normal BMI, below 25.
In a recent review, the risk over several years of developing diabetes was about 6.4 percent in people not on statins, and about 10 percent in people taking statins. This suggests that about one person in 28 taking a statin will develop diabetes due to the statin. Stopping it probably will not reverse the diabetes.
On the other hand, statins reduce the risk of heart attack, death and stroke in people at high risk for these conditions.
I understand that you are very concerned about developing diabetes; however, if you’d seen the effect that strokes can have on previously healthy people as often as I have, I think you would change your mind about which is worse. The vast majority of people with diabetes do very well with a proper diet, regular exercise and sometimes medication. A stroke can be devastating.
Statins should not be used indiscriminately, without thinking about the risks and the benefits.
I have written several times about risks of statins, particularly the muscle aches that happen occasionally, as well as the muscle damage that happens rarely.
In people at low risk, statins may hurt more than they help. However, in people at high risk — especially those who already have blockages in the vessels of the heart, brain or peripheral arteries — statins save lives, prevent heart attacks and help prevent debilitating strokes.
Your doctor needs to take everything into consideration, such as family history, your blood pressure and cholesterol, smoking habits and other factors, including your own preferences about medication, and give you the best advice about taking these occasionally harmful but far more often helpful medications.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.