I’m an integrative physician. I get a LOT of people coming to see me thinking that I will tell them they don’t need to take meds for this or that problem. One of the most common is statins. Recently more and more people have been concerned about the link between statins and diabetes risk.
Statins are drugs that are prescribed to lower cholesterol and prevent heart attacks and strokes. It is very clear that they are effective in reducing the risk of a second heart attacks in people who have already had one. However, many doctors prescribe them regularly for those who have no evidence of an increased heart disease risk.
Statins are generally very safe, but more recently there has been a growing awareness that they are linked to an increased risk of type 2 diabetes. They also seem to make blood sugar control a little bit worse in some people who already have diabetes.
So what is the actual risk? Before people flatly refuse to discuss them (or doctors blindly prescribe them) we should know the risks we are talking about. I have been using an evidence-based medicine website called thennt.com to review treatments. NNT refers to Number Needed to Treat. How many people do we have to treat to benefit one patient? Conversely NNH is Number Needed to Harm. How many people do we have to treat to HURT one patient?
Low Cardiovascular Risk
Patients who have less than a 20% risk of a heart attack over the next 10 years did not seem to benefit from taking a statin. It did not prevent overall deaths, and the NNT for preventing nonfatal heart attacks was 217 (313 for nonfatal stroke)
On the other hand, one in 204 patients treated with statins in the low-risk group developed diabetes, and one in 21 developed muscle pain bad enough they had to stop or switch medications.
High Cardiovascular Risk
Patients who already have had a heart attack or who have documented coronary heart disease are another story altogether. These patients are usually treated with higher doses of statins (the highest available or highest tolerable dose, typically).
Over 5 years, one in 83 high-risk patients avoided a fatal cardiovascular event due to taking statin drugs. One in 39 avoided a nonfatal heart attack, and one in 125 avoided a nonfatal stroke. For those who have had a heart attack or stroke or have known heart disease, statins are lifesaving drugs.
On the other hand, because of the higher doses involved, they also have more risks. One in 10 had significant muscle pain. One in 50 developed diabetes (that they wouldn’t have developed if they hadn’t taken the drug).
So one in 50 developed diabetes, but one in 83 DIDN’T DIE from a cardiovascular death, due to taking a statin. Having diabetes is NOT a fate worse than death.
What else can we do for preventing heart attacks, instead of taking statins? As I tell everyone, CHANGE YOUR DIET! In fact, diet is MORE effective than statin drugs for preventing some cardiovascular events.
The Mediterranean diet (about which there are gazillions of websites, books, cookbooks, how-to’s, etc.) is effective for preventing death and cardiovascular events. One in 61 patients avoided death or a nonfatal heart attack or stroke by following the Mediterranean diet.
In short, statins are effective in those who are at high risk of cardiovascular events, but not in those who are at lower risk. There is a link between treatment with statins and diabetes risk. However, in high risk patients the benefit (reducing death and nonfatal cardiovascular events) seems to outweigh the risk (diabetes and muscle pain). In all patients, diet and lifestyle change is an integral part of cardiovascular risk reduction.
QUESTION: Do you take a statin? Does this information make you more or less anxious about it?