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Statins and diabetes risk: how real is it and what are the mechanisms?
Curr Opin Lipidol 2015; 26(3):228-35CO

Abstract

PURPOSE OF REVIEW

In randomized trials and many observational studies, statins are associated with a modest excess of type 2 diabetes mellitus. High-intensity statins, such as atorvastatin 80 mg and rosuvastatin 20 mg, are associated with a higher excess risk of diabetes than moderate-intensity statins, such as atorvastatin 10 mg, simvastatin 20-40 mg, or pravastatin 40 mg.

RECENT FINDINGS

Multiple mechanisms have been proposed for statin-associated diabetes risk, primarily related to increased insulin resistance or impaired insulin secretion. Genetic polymorphisms with reduced HMG CoA reductase function are associated with weight gain, insulin resistance, and diabetes. Animal models have shown that HMG CoA inhibition has multiple downstream effects that may increase diabetes risk. Statin impairment of insulin signaling, decreased adipocyte differentiation, decreased pancreatic β-cell insulin secretion, and other effects have also been found. The excess risk of diabetes appears to be confined to those who are already at risk for developing diabetes. Diabetes is diagnosed only 2-4 months earlier in statin-treated patients and therefore is unlikely to have no long-term adverse consequences.

SUMMARY

The clinical impact of statin-associated diabetes is likely unimportant. The cardiovascular risk reduction benefit from statin far outweighs the potential for adverse effects in all but the very lowest risk individuals.

Authors+Show Affiliations

aDepartment of Epidemiology bDepartment of Medicine cPrevention Intervention Center, University of Iowa, Iowa City, Iowa, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25887679

Citation

Robinson, Jennifer G.. "Statins and Diabetes Risk: How Real Is It and what Are the Mechanisms?" Current Opinion in Lipidology, vol. 26, no. 3, 2015, pp. 228-35.
Robinson JG. Statins and diabetes risk: how real is it and what are the mechanisms? Curr Opin Lipidol. 2015;26(3):228-35.
Robinson, J. G. (2015). Statins and diabetes risk: how real is it and what are the mechanisms? Current Opinion in Lipidology, 26(3), pp. 228-35. doi:10.1097/MOL.0000000000000172.
Robinson JG. Statins and Diabetes Risk: How Real Is It and what Are the Mechanisms. Curr Opin Lipidol. 2015;26(3):228-35. PubMed PMID: 25887679.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Statins and diabetes risk: how real is it and what are the mechanisms? A1 - Robinson,Jennifer G, PY - 2015/4/19/entrez PY - 2015/4/19/pubmed PY - 2016/2/13/medline SP - 228 EP - 35 JF - Current opinion in lipidology JO - Curr. Opin. Lipidol. VL - 26 IS - 3 N2 - PURPOSE OF REVIEW: In randomized trials and many observational studies, statins are associated with a modest excess of type 2 diabetes mellitus. High-intensity statins, such as atorvastatin 80 mg and rosuvastatin 20 mg, are associated with a higher excess risk of diabetes than moderate-intensity statins, such as atorvastatin 10 mg, simvastatin 20-40 mg, or pravastatin 40 mg. RECENT FINDINGS: Multiple mechanisms have been proposed for statin-associated diabetes risk, primarily related to increased insulin resistance or impaired insulin secretion. Genetic polymorphisms with reduced HMG CoA reductase function are associated with weight gain, insulin resistance, and diabetes. Animal models have shown that HMG CoA inhibition has multiple downstream effects that may increase diabetes risk. Statin impairment of insulin signaling, decreased adipocyte differentiation, decreased pancreatic β-cell insulin secretion, and other effects have also been found. The excess risk of diabetes appears to be confined to those who are already at risk for developing diabetes. Diabetes is diagnosed only 2-4 months earlier in statin-treated patients and therefore is unlikely to have no long-term adverse consequences. SUMMARY: The clinical impact of statin-associated diabetes is likely unimportant. The cardiovascular risk reduction benefit from statin far outweighs the potential for adverse effects in all but the very lowest risk individuals. SN - 1473-6535 UR - https://www.unboundmedicine.com/medline/citation/25887679/Statins_and_diabetes_risk:_how_real_is_it_and_what_are_the_mechanisms L2 - http://dx.doi.org/10.1097/MOL.0000000000000172 DB - PRIME DP - Unbound Medicine ER -