Risk of diabetes with statins
BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2022-071727 (Published 12 May 2023) Cite this as: BMJ 2023;381:e071727
- Ishak A Mansi, professor of medicine1,
- Priya Sumithran, principal research fellow2,
- Mustafa Kinaan, assistant professor of medicine3
- 1Department of Education, Orlando VA Health Care System, Orlando, Florida
- 2Department of Medicine (St Vincent’s), University of Melbourne, Melbourne, Australia
- 3Department of Internal Medicine, University of Central Florida, Orlando
- Correspondence to I Mansi ishak.mansi{at}UTSouthwestern.edu
What you need to know
Statins are associated with a small increased risk of new-onset diabetes, which is higher in people with other risk factors for diabetes, and in association with high intensity statins and older age
When starting a patient on statins, emphasise the importance of lifestyle modifications, including healthy diet and physical activity
Consider monitoring blood glucose levels when starting or intensifying statin therapy (although no evidence based guidance is available for how often this monitoring should occur)
A 65 year old white man is presenting for his routine check-up. He has no history of smoking, hypertension, diabetes, or cardiovascular disease, and takes no regular medications. His total cholesterol is 5.25 mmol/L, low density lipoprotein (LDL) cholesterol is 3.34 mmol/L, and high density lipoprotein (HDL) cholesterol is 1.5 mmol/dL. His blood pressure is 125/70 mm Hg. He is attempting to adhere to a heart-healthy lifestyle. You discuss whether to start a statin for primary prevention of cardiovascular disease.
The patient is aware of the benefit of statins in lowering the risk of cardiovascular disease, but has read media reports that statins cause diabetes. He asks about the magnitude of the risk of developing diabetes, and how to minimise it, to help him decide whether to take a statin. How would you advise him?
How do statins affect blood glucose?
Statins are medications that lower blood cholesterol. They act by inhibiting the 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase enzyme, which catalyses the principal rate-limiting step in cholesterol synthesis by the liver.1
Statins are generally well tolerated and have shown benefits in lowering cardiovascular morbidity and mortality.2 However, their association with an increased risk of new onset diabetes led the US Food and Drug Administration to approve a label revision in 2012 to add that increases in glycated haemoglobin (HbA1c) and fasting glucose levels have been reported with statins.3 The …
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