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Do statins cause diabetes?
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Life would be so much easier if there were binary, yes and no answers to every question that was important to us.
But there isn’t.
Almost everything comes down to probabilities.
Does speeding cause car crashes?
No.
But it does seriously increase the risk of one.
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But there isn’t.
Almost everything comes down to probabilities.
Does speeding cause car crashes?
No.
But it does seriously increase the risk of one.
/2
We could eliminate car crashes entirely by banning driving
But we can all agree that the net harm to society would likely be unacceptable.
It all comes down to:
Your priorities
Your objectives
Your risk tolerance
Your ability to update a risk model
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But we can all agree that the net harm to society would likely be unacceptable.
It all comes down to:
Your priorities
Your objectives
Your risk tolerance
Your ability to update a risk model
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But most importantly:
Where you draw the line of ‘risk’ equating to ‘causation’.
The same is true when it comes to the question of statins ‘causing’ diabetes.
Let's start with looking at the Jupiter Trial.
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Where you draw the line of ‘risk’ equating to ‘causation’.
The same is true when it comes to the question of statins ‘causing’ diabetes.
Let's start with looking at the Jupiter Trial.
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The Jupiter trial showed that in patients with
Relatively normal LDL-C & ⬆️ CRP
That the use of Statin therapy significantly ⬇️ cardiovascular events.
-44% ⬇️ in major heart events
- 20% ⬇️ in All-Cause Mortality
However, the was a signal of ⬆️ diabetes with the statin
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Relatively normal LDL-C & ⬆️ CRP
That the use of Statin therapy significantly ⬇️ cardiovascular events.
-44% ⬇️ in major heart events
- 20% ⬇️ in All-Cause Mortality
However, the was a signal of ⬆️ diabetes with the statin
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Out of 17,802 people in the trial
The occurrence of newly diagnosed diabetes looked like this:
Placebo - New Onset Diabetes - 216 cases
Rosuvastatin - New Onset Diabetes - 270 cases
An approximate 25% relative increased risk.
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The occurrence of newly diagnosed diabetes looked like this:
Placebo - New Onset Diabetes - 216 cases
Rosuvastatin - New Onset Diabetes - 270 cases
An approximate 25% relative increased risk.
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Meta-analysis of multiple statin trials has shown this to be a consistent finding
With an average 11% increased risk of new-onset diabetes across these studies.
This risk is higher when higher-intensity statin therapy is used.
What to do?
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With an average 11% increased risk of new-onset diabetes across these studies.
This risk is higher when higher-intensity statin therapy is used.
What to do?
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As with every question of this kind, the devil really is in the detail.
The question is..
Was the risk of new-onset diabetes evenly distributed across ALL the people in the trial?
No.
Not even close.
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The question is..
Was the risk of new-onset diabetes evenly distributed across ALL the people in the trial?
No.
Not even close.
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80% of the people in the JUPITER trial who went on to develop diabetes
Already had evidence of impaired fasting glucose at the start of the trial.
They did not have diabetes at the start of the trial, but they were WELL on their way.
There were many other signals of risk
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Already had evidence of impaired fasting glucose at the start of the trial.
They did not have diabetes at the start of the trial, but they were WELL on their way.
There were many other signals of risk
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In addition to ⬆️ fasting glucose other risk factors for developing diabetes, included:
- Metabolic syndrome
- BMI > 30 (Obese)
- Elevated HBA1c - Not in the diabetes category but above normal.
Having any of these factors ⬆️ the risk of diabetes by 10 FOLD.
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- Metabolic syndrome
- BMI > 30 (Obese)
- Elevated HBA1c - Not in the diabetes category but above normal.
Having any of these factors ⬆️ the risk of diabetes by 10 FOLD.
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In those who were already likely to develop diabetes.
Statin therapy likely just pulled forward their diagnosis of diabetes.
By how long?
About 5 weeks.
So yes... statin therapy does ⬆️ the risk of diabetes
But mostly in those who were already at high risk.
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Statin therapy likely just pulled forward their diagnosis of diabetes.
By how long?
About 5 weeks.
So yes... statin therapy does ⬆️ the risk of diabetes
But mostly in those who were already at high risk.
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Did those who went on to diabetes
Have less of a benefit from statin therapy in terms of preventing heart attacks and strokes?
For every 100-200 people treated with a statin - 1 added case of diabetes will result.
But the expected benefit is 10-fold greater.
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Have less of a benefit from statin therapy in terms of preventing heart attacks and strokes?
For every 100-200 people treated with a statin - 1 added case of diabetes will result.
But the expected benefit is 10-fold greater.
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Why do statins increase the risk of diabetes?
It's not entirely clear why but in general, it is thought that
In those with preexisting insulin resistance, it can make it worse.
What to do?
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It's not entirely clear why but in general, it is thought that
In those with preexisting insulin resistance, it can make it worse.
What to do?
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Lifelong low APOB/LDL-C is associated with very low rates of cardiovascular disease.
Statin therapy is a very reliable method of achieving that goal.
Insulin resistance is a major amplifier of risk that can be reversed with
Good nutrition &
Regular exercise.
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Statin therapy is a very reliable method of achieving that goal.
Insulin resistance is a major amplifier of risk that can be reversed with
Good nutrition &
Regular exercise.
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The main takeaway is that statin therapy does result in a small increased risk of newly diagnosed diabetes
But....
80% of the time, it is in those who were likely to develop diabetes at some point anyway.
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But....
80% of the time, it is in those who were likely to develop diabetes at some point anyway.
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So please do not be scared by the shock tactics used by some of those online when they talk about this topic.
The answer is nuanced.
Your approach requires this.
But there is always a way to navigate the problem.
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The answer is nuanced.
Your approach requires this.
But there is always a way to navigate the problem.
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That's a wrap!
If you enjoyed this thread:
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If you enjoyed this thread:
👋 You might like to join 10K+ others on my free weekly newsletter on heart disease prevention and living longer.
If so, just click my Bio above and follow the link.
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