What are statins and how do they work?
If you have been diagnosed with high cholesterol, your doctor may have recommended that you take a statin. But what are statins, and why are they prescribed?
Statins are a class of drugs that is used to lower cholesterol levels in the body. NHS defines statins as follows: “Statins are a group of medicines that can help lower the level of low-density lipoprotein (LDL) cholesterol in the blood.” They work by blocking an enzyme that helps to produce cholesterol in the liver.
If you have high levels of LDL cholesterol, it can accumulate on the walls of your arteries, forming what's called plaque. This buildup narrows your blood vessels and makes it more difficult for blood to flow through them. This increases the risk for atherosclerosis, coronary heart disease and cardiovascular disease (CVD), which is why people are prescribed statins to reduce their risk of heart attack or stroke.
Some new research suggests that the cholesterol may not even be the cause of these diseases mentioned, but more evidence is needed.
Different statins
There are many different types of statins on the market such as like Fluvastatin, Simvastatin, Atorvastatin to name a few. These are sold and marketed with names like Mevacor®, Flolipid®, Zocor® and Lipitor®, which is the best selling statin in the pharmaceutical in history. The manufacturer Pfizer reported sales of US$12.4 billion in 2008.
Although statins are generally safe and well-tolerated, there are some risks associated with their use. For example, some patients experience muscle aches, headaches, or nausea when starting a statin regimen. Also it may might not work, so usually different types of statins have to be tried to find a suitable label that lowers the LDL cholesterol and the side effects are tolerable.
Are statins linked to diabetes?
There is a substantial amount of research linking statins to an increased risk of type 2 diabetes.
It has been clear since 2010 that statins cause diabetes, but the question is: How much?
Let's look at the latest scientific evidence.
One of the long-term studies with ten year follow-up is the one from the University of Texas Southwestern Medical Center. It suggests that there is a risk of a 33%-37% higher risk of developing diabetes compared to those who did not take statins. The researchers theorize that the increased risk of diabetes may be due to the fact that statins can reduce insulin sensitivity in the body. This could make it harder for the body to process sugar and lead to higher blood sugar levels.
Larger meta-studies have confirmed the link between statins and diabetes in randomised statin trials, but only with a 9% increased risk association.
What about cohort studies? In 2015 the Journal of General Internal Medicine published a retrospective cohort study of 25,970 patients that found an 87% increase in diabetes, but also more evidence of increased obesity and decreased exercise capacity.
New research links statin use to even higher rates of diabetes
It's well-established that statin drugs cause diabetes, but some argue that the studies are not properly designed. Some other questions are short and long term use compared to non-users. So the relationship between the drug and the disease also depends on the study design and how the participants are recruited.
That is why Andrew J. Foy and his research group designed a study with 442,526 patients that addressed the selection bias. The study was designed to find out the difference between non-users and statin users in the US.
Foy explains his hypothesis for the study: "Our hypothesis was straightforward: if selection bias is a major contributor to the incidence of diabetes in observational study designs, then the association between statin use and diabetes will be much stronger in the statin exposed vs unexposed group than in the statin continuer vs discontinuer group. This is because all patients in the statin continuer vs discontinuer group would have been selected—by a clinician—for statin use."
The study published on January 2023, in the American Journal of the Medical Sciences found a 120% increase in diabetes rates in people taking statins.
What is the risk of developing diabetes as a result of taking statins?
You have just read that statins, a type of cholesterol-lowering medication, are linked to higher diabetes rates. The facts are concerning, but it's important to understand what statins are and why they're prescribed before making any decisions about your own health.
While the research shows statin use to higher diabetes rates, it's important to keep in mind that the absolute risk of developing diabetes while taking a statin is still relatively low. And for many people, the benefits of taking a statin outweigh the risks. If you're concerned about the potential link between statins and diabetes, talk to your doctor about your individual risk factors and whether a statin is right for you.
Studies don't usually address the different types of statins, and whether you develop diabetes depends on many other factors - especially your lifestyle and diet. Because drugs always have side effects, it always comes down to weighing the benefits against the risks.
How does this affect you?
According to scientific studies, the risk of developing diabetes is between 9% and 120% higher with long-term statin use than with non-statin users. Statins have also been linked to other problems in the body and brain, such as the development of Parkinson's disease. This is not surprising, since cholesterol is the precursor of all steroid hormones and bile acids, and our brains have the highest level of cholesterol in the body, about 20% of total body cholesterol.
If you are considering stating or stopping statins, it is important to discuss the potential risks and benefits with your doctor who specializes in lifestyle medicine before changing your treatment regimen.
Doctors and health coaches who are following the scientific advances in treating cardiovascular disease through behavioral changes understand the benefits of a healthy lifestyle and will suggest lifestyle changes along with your medications - weight management, exercise, smoking cessation and a healthy diet as key elements.
App to Develop Healthy Habits
Better options for lowering cholesterol
Your body needs cholesterol, but the high LDL levels are often associated with cardiovascular health issues that the statin medications address.
It's been known for decades that atherosclerotic cardiovascular disease (ASCVD) is an inflammatory disease. That is, the buildup of plaque in the arteries is promoted by ongoing inflammation in the veins.
It's also clear that healthy habits including restful sleep, healthy diet, exercise, and low alcohol consumption lowers considerable the risk of cardiovascular disease incidents. That's probably and mostly because they all reduce inflammation in the body.
The Mediterranean Diet and Ornish Diet have both been shown highly beneficial and are increasingly recommended for their health benefits. Following a plant-based diet has been shown to reduce risk of CHD (coronary heart disease) by 65% and stroke reduction by 40%.
In fact, the reports from doctors and health coaches using the Habinator Coaching Platform that they can get their patients off the statins in as little as six weeks when they start following the principles of lifestyle medicine. Since lifestyle modifications are the most important component of cardiovascular disease prevention, it should always be considered first before considering pharmacological interventions such as statins.
Conclusion
Statins are prescribed to people with high cholesterol and cardiovascular disease to lower their cholesterol and reduce their risk of a heart attack or stroke.
Because our bodies and brains need cholesterol to function optimally, the risk of cholesterol building up in the arteries and causing blockages is a concern that must be always considered on an individual basis.
The scientific consensus is that statins are associated to an increased risk of diabetes, but the benefits usually outweigh the risks. It is important to discuss with your doctor whether a statin is a right choice for you because it can be life-saving. If you and your doctor decide that a statin is right for you, be sure to stay active and eat a healthy diet - both of which can help reduce your risk of developing type 2 diabetes.
There are also alternatives to statins that address the root cause of the problem that is the high LDL cholesterol that is caused by lifestyle factors such as sedentary lifestyle, sleep quality, and poor eating habits.