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.
Key Points to Consider
- The cardiovascular benefits of statin therapy typically outweigh the risk of developing type 2 diabetes, especially for patients with existing cardiovascular disease or high risk factors.
- Common statins include atorvastatin, rosuvastatin, and simvastatin, and patients taking these medications should have their blood glucose monitored regularly, particularly in the first year of treatment.
- Those already at risk for diabetes, such as individuals with obesity, family history, or metabolic syndrome, should be especially vigilant.
- The diabetes risk appears dose-dependent, with higher statin doses carrying greater risk, and the mechanism behind this relationship involves statins reducing insulin sensitivity and secretion while impairing glucose uptake in muscle cells.
Recent Evidence
A 2024 meta-analysis found that statin therapy causes a moderate dose-dependent increase in new diagnoses of diabetes, and that most of the excess of new-onset diabetes occurs among individuals who are already at high risk of diabetes 1. Another study published in 2024 found that the cardiovascular benefits of statin therapy greatly outweigh the risks of new-onset diabetes, despite the small increased risk of diabetes associated with statin use 1.
Clinical Implications
Patients with diabetes should not stop taking statins without consulting their healthcare provider, as the cardiovascular protection they provide is substantial, especially for secondary prevention. The maximally tolerated statin dose should be used for patients who do not tolerate the intended intensity of statin therapy, and high-intensity statin therapy is recommended for patients who can tolerate it, as it achieves an approximately ≥50% reduction in LDL cholesterol 1.
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 an increased risk of new-onset diabetes, particularly in patients at risk for developing diabetes 3, 4, 5, 6.
- The risk of developing diabetes is more relevant with high-intensity statin treatment rather than low-intensity statin treatment 3, 6.
- Lipophilic statins are suggested to be more diabetogenic than hydrophilic statins 3.
- Mechanisms explaining statin diabetogenicity include impaired insulin secretion by pancreatic β cells and increased insulin resistance of various tissues 3.
Benefits of Statin Therapy
- The cardiovascular benefits of statin therapy outweigh the risk of developing diabetes 3, 4, 5, 6.
- Statin therapy is associated with significant reductions in cardiovascular events in a wide range of patient populations 5.
- The number of cardiovascular disease events prevented for each excess case of diabetes is close to or greater than one, indicating a favorable risk-benefit ratio for statin therapy 6.
Clinical Recommendations
- Patients at risk for developing diabetes should be prescribed statins with caution 3.
- Physicians should assess all patients for diabetes risk prior to starting statin therapy and educate patients about their risks 5.
- Statin-treated patients at high risk of developing diabetes should be regularly monitored for changes in blood glucose or HbA1c levels 5.
- Lifestyle modification is emphasized for management of risks for both diabetes and cardiovascular disease events in patients receiving statin therapy 4, 5, 6.
Impact of Statin Nonacceptance
- Delaying statin therapy is associated with a higher cardiovascular risk in patients with diabetes 7.
- Statin nonacceptance is an independent risk factor for myocardial infarction and ischemic stroke in patients with diabetes 7.
- Higher low-density lipoprotein cholesterol levels are associated with a higher incidence of adverse cardiovascular events in patients with diabetes who delay statin therapy 7.