From the Guidelines
Statin therapy is indicated for primary prevention in patients 40 to 75 years of age with diabetes, as it reduces the risk of ASCVD events by 25%. This recommendation is based on the most recent and highest quality study, which found that moderate-intensity statin therapy was associated with a significant reduction in ASCVD events in patients with diabetes 1. The benefits of statin therapy in reducing cardiovascular risk outweigh the potential risk of developing type 2 diabetes, particularly in patients with established cardiovascular disease or high cholesterol.
Some key points to consider when prescribing statin therapy to patients with diabetes include:
- Monitoring blood glucose levels regularly, particularly during the first year of therapy
- Lifestyle modifications, such as regular exercise, healthy diet, and weight management, to mitigate the diabetes risk while on statin therapy
- Choosing the appropriate statin dose and intensity, with high-intensity statin therapy achieving an approximately ≥50% reduction in LDL cholesterol, and moderate-intensity statin regimens achieving 30–49% reductions in LDL cholesterol 1
- Being aware of the potential for statin therapy to cause a moderate dose-dependent increase in new diagnoses of diabetes, particularly in individuals who are already at high risk of diabetes 1
Overall, the benefits of statin therapy in reducing cardiovascular risk in patients with diabetes outweigh the potential risks, and statin therapy should be considered a crucial component of comprehensive cardiovascular risk management in these patients.
From the FDA Drug Label
Increases in HbA1c and fasting serum glucose levels have been reported with statins, including rosuvastatin. Based on clinical trial data with rosuvastatin, in some instances these increases may exceed the threshold for the diagnosis of diabetes mellitus [see Adverse Reactions (6. 1)] . Statin use, including rosuvastatin, may be associated with increases in HbA1c and fasting serum glucose levels, potentially leading to a diagnosis of diabetes mellitus 2.
- Key points:
- Increases in HbA1c and fasting serum glucose levels have been reported with statin use.
- These increases may exceed the threshold for the diagnosis of diabetes mellitus.
- Optimize lifestyle measures, including regular exercise, maintaining a healthy body weight, and making healthy food choices to minimize the risk of developing diabetes mellitus while taking rosuvastatin 2.
From the Research
Statin Use and Diabetes Risk
- Statins are associated with a modest excess of type 2 diabetes mellitus, with high-intensity statins posing a higher risk than moderate-intensity statins 3, 4, 5.
- The excess risk of diabetes appears to be confined to those who are already at risk for developing diabetes, and diabetes is diagnosed only 2-4 months earlier in statin-treated patients 3.
- The clinical impact of statin-associated diabetes is likely unimportant, as the cardiovascular risk reduction benefit from statin far outweighs the potential for adverse effects in all but the very lowest risk individuals 3, 4.
Mechanisms of Statin-Associated Diabetes Risk
- Multiple mechanisms have been proposed for statin-associated diabetes risk, primarily related to increased insulin resistance or impaired insulin secretion 3.
- Genetic polymorphisms with reduced HMG CoA reductase function are associated with weight gain, insulin resistance, and diabetes 3, 5.
- Statin impairment of insulin signaling, decreased adipocyte differentiation, decreased pancreatic β-cell insulin secretion, and other effects have also been found to contribute to the increased risk of diabetes 3.
Clinical Implications
- Patients should be warned about a slight diabetes risk when prescribed statin and told that modest lifestyle improvements can nullify diabetes risk and improve cardiovascular risks beyond statins 5.
- Doctors should measure glycemia status post statin commencement, most commonly with HbA1c, and tailor lifestyle advice and care dependent on the results 5.
- The importance of lifestyle management and other preventive measures is emphasized for management of risks for both type 2 diabetes and cardiovascular disease events in patients receiving statin therapy 4.
Impact of Statin Nonacceptance on Cardiovascular Outcomes
- Delaying statin therapy is associated with a higher cardiovascular risk, mediated by higher low-density lipoprotein cholesterol levels 6.
- Among patients with diabetes, those who delayed statin therapy had a significantly higher cumulative 10-year rate of myocardial infarctions and ischemic strokes compared to those who initiated statins immediately 6.