Diabetes-Risk Associated With Statin Use Interview with:
Fariba Ahmadizar, PharmD, MSc, PhD
Department of Epidemiology
Erasmus University Medical Centre
Rotterdam, the Netherlands What is the background for this study?

Response: Several observational studies and trials have already reported an increased risk of incident type 2 diabetes in subjects treated with statins; however, most of them lack details, meaning that there were limited studies on the association of statin use with glycemic traits. Studies on this association underestimated type 2 diabetes incident cases due to including either questionnaire-based data, short follow-up time or lack of a direct comparison between different statin types, dosages and duration of use with respect to diabetes-related outcomes. What are the main findings?

Response: Compared to never statin users, baseline use of statin was associated with higher levels of serum fasting insulin (β, 0.07; 95% CI: 0.02-0.13) and insulin resistance (β, 0.09; 95% CI: 0.03-0.14). Our finding suggests that the association between statins and diabetes could be through insulin secretion/resistance. We also found that ever use of statins was associated with a 38% higher risk of incident type 2 diabetes (HR, 1.38; 95% CI: 1.09-1.74). When we stratified the later analysis by baseline BMI, we showed higher risk of diabetes in a subset of overweight/obese subjects but not in those with normal weight. Statin had also a significant statistical interaction with baseline glucose levels leading to exert the highest risk of incident type 2 diabetes in presence of hyperglycemia. What should readers take away from your report? 

Response: The most important point of our study is to give patients/clinicians a hint to take statin’ diabetogenicity” into consideration when statin is initiated, particularly in at high-risk patients.

We don’t want to scare people away from statin use. The beneficial effect of statins in primary and secondary prevention of CVD is obvious, according to the evidence. Our analysis highlights the greatest diabetogenic effect of statins in presence of other diabetes risk factors including hyperglycemia and overweight/obesity; therefore, effective interventions such as exercise and weight loss in individuals with high-risk taking statins might help minimizing this unfavorable effect of statins. What recommendations do you have for future research as a result of this work? 

Response: In our study, the majority of patients were on lipid‐soluble statins (simvastatin, atorvastatin and fluvastatin), while the number of patients on water‐soluble statins (pravastatin) was low. Therefore, due to different actions of specific molecules of statins on insulin resistance and metabolic risk profiles, we recommend for future research. 

Disclosures: This study was conducted at the Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands. In addition, individuals from the Rotterdam Study, a prospective population‐based cohort study in Ommoord, a district of Rotterdam, were included in this study. Dr. Fariba Ahmadizar, PharmD, MSc, PhD is a postdoctoral scientific researcher employed by Erasmus University Medical Centre. Neither Dr Ahmadizar nor professor Stricker have any financial or other interests regarding this paper.

Citation:  Ahmadizar F, OchoaRosales C, Glisic M, Franco OH, Muka T, Stricker BH. Associations of statin use with glycaemic traits and incident type 2 diabetes. Br J Clin Pharmacol. 2019.

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Last Updated on March 8, 2019 by Marie Benz MD FAAD