Statins & Diabetes. A Step-by-Step Guide

Do Statins cause Diabetes? What factors determine diabetes risk on a statin and how can we avoid it? A step-by-step guide to statin use and diabetes risk

Part II of the statin series focuses on diabetes.

In some trials statins raise risk of diabetes, in others statins have no significant effect, in others statins lower risk of diabetes.

some meta-analyses find statins raise risk of diabetes, others find no significant effect of statins on risk of diabetes.

risk of diabetes on a statin are determined by diabetes risk factors, statin dose and statin type.

people with risk factors for diabetes (obesity, Metabolic syndrome, pre diabetes; fasting glucose or glycated hemoglobin above normal but not in diabetic range), statins reduce cardiovascular risk (heart attacks, strokes) but increase risk of diabetes. For people without diabetes risk factors, statin reduces cardiovascular outcomes with no significant increase in diabetes risk

risk of diabetes on a statin mainly a concern for people already at risk of diabetes; both with and without diabetes risk factors the benefits of the statin outweigh the risks

“cardiovascular and mortality benefits of statin exceed diabetes hazard, including among those at higher risk for developing diabetes”

absolute terms: 2 cardiovascular events avoided per new case of diabetes, in people at higher risk of diabetes

Some statins raise diabetes risk, some don't. e.g. Pravastatin and pitavastatin

talking to a cardiologist I would factor in diabetes risk factors, consider lower dose or a statin that doesn´t raise risk and follow fasting glucose and HbA1c, glycated hemoglobin

why do some statins raise risk of diabetes? they may raise BMI which raises insulin resistance & diabetes. maintaining healthy body weight via diet and exercise while on a statin may lower risk

Sometimes people claim statins double risk of diabetes based on observational studies. when adjusted, the effect is cut in half and fasting blood glucose becomes non significant. Also, the effect differed by statin type, it was strongest with atorvastatin and not significant with most other statins like pravastatin or pitavastatin

most long observational studies show a diabetes risk of atorvastatin and rosuvastatin, while pravastatin and pitavastatin show no significant effect

based on this, I would assess diabetes risk factors, obesity, pre-diabetes, i´d lean toward statins that don´t increase risk, e.g. pravastatin or pitavastatin, If we need atorvastatin or rosuvastatin, i´d favor moderate dose. If it doesnt bring cholesterol down enough, i´d rather add ezetimibe or pcsk9 inhibitors rather than crank up statin dose.

and keep an eye on glycemia and keep lifestyle healthy

Connect with me:
Animations: Even Topland @toplandmedia

References:

Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.

#NutritionMadeSimple #GilCarvalho

0:00 Introduction
0:52 Disclaimer
1:20 The setup
3:12 Statins & Diabetes risk
5:24 Diabetes risk factors
10:39 Statin dose
12:53 Statin types
15:24 Putting them together
16:46 Mechanisms
17:20 Observational evidence
20:08 Funding
20:52 Summary
22:24 Importance of information quality

[hevoforo]

This is outstanding. Period. Nothing I've read/watched comes close to how well you have organized, reviewed, and presented the information. That says a lot - I'm a retired health care provider!

[doernerrr]

IMO one of the best videos ever on the subject of statins and potential side effects. Neither my PCP or cardiologist would ever take the time to discuss the issue at this level of detail. They make recommendations but I have no idea how current their knowledge is or what factors they considered. So I’ve refused statins and am making a heroic effort to control my cholesterol through lifestyle choices. But now, with the benefit of this new information and a better understanding of relative risks, I may reconsider my choice. Keep up the good work and thanks.

[thehylander]

The most underrated but best channel on nutrition/health!

[floridasailor]

This was amazingly helpful. I've been paralyzed with indecision over this very topic, with no way to sort through all the conflicting info. Thanks so much. I can't imagine how many lives you might save with this video.

[liveloveride]

Great content, I combine ezetimibe 10mg with rosuvastatin 10mg, I take ezetimibe every day and rosuvastatin every other day and my LDL is 62.65, my age is 61 and I am very happy with this regime, keep spreading the truth to the good people.

[Surfsailwaves]

Deciding whether or not to take a statin, even for a scientist with university level biochemistry and physiology, is a friggin’ nightmare, no thanks to the statin-wars and numerous grifters who are selling anti-statin scare books, diets etc. I am so glad I found this set of calm, logical and well-reasoned videos. Excellent stuff - big thanks.

[matthewtomaszewski]

I’ve watched several videos since my cardiologist put me on a statin and this was by far the best. He’s a great teacher.

[DrBradStanfield]

Well done Gil. Stellar video. Statins can be a lifesaving treatment. Going through the side effect research like this so that people can make more informed decisions is such a valuable service

[gchrysos]

This helps a lot - there are so many confusing MDs and PhDs on youtube that make strong and totally contradictory statements about statins. This was a super clear and useful framework to understand the whole landscape.

[gloriaeason]

Liver damage uncontrolled blood sugar and muscle aches. Went on a statin twice.Has taken me two years to recover my liver and I still haven’t completely recovered

[skyburger-bt]

Doctor, Your videos are top shelf!!! Please keep making them. This one in particular was very helpful to me. Please address rhabdomyolysis & how often it occurs with statin use along with other muscle or organ related problems. You're my go to physician to get quality & reliable information online! Thanks for all you do for humankind!

[lainrich]

I'm so grateful to you, Gil, for making these videos. I feel I won the lottery when I discovered your channel. I am one of the countless who have tried to navigate health information on the internet, and was constantly swayed by conflicting information. Who to believe? What decision to make? How to navigate the endless information? i finally feel that I found a way to navigate the information, with the help of your videos. Thank you from the bottom of my heart. By the way, your Mom is one lucky lady to have you in her life!

[carstars]

This is the best description of this problem for diabetics. Thanks.

[Viva-Longevity]

Such a great video. I re-watched it a year later to check my memory of it.

[krisfarrugia]

You are the voice of reason, your message needs to heard by many others!

[terber]

Dr. Carvalho I cannot express how much your channel has helped me. I currently have to make the decision about starting a statin, I am 67 y.o. female. I felt I was having to make a decision between either having cardio disease or diabetes because I had seen all the ballyhoo and the negative studies about statins and diabetes and my whole reason for starting to improve my health status 2 years ago was to prevent becoming diabetic. Your series here on statins has helped me greatly to understand the studies and misinformation (especially about relative and absolute risks) of statins and to make my decision to agree to a low dose statin and to continue to decrease my risk of DM by losing more weight and increasing my exercise. I will be monitoring my fasting glucose and hemoglobin A1C. Thank you so much for this channel. You have helped me feel much more confident and comfortable with my decision to start a statin.

[NaturallyAspirated]

I am glad to find this reflection on the studies.
I was on Atrovastatins for over 20 years since I was 30, stuck to Mediterranean diet as recommended by my GP. Every two or three years my total Cholesterol count gone up a bit and so the GP elevated my dose up to 80mg/day.
With no family history of T2D or change in diet, now at the age of 53 I find myself with T2D and rising cholesterol levels.
My GP retired during the Pandemic and my be practitioner offered me to go on Iclesirian. I think I'll take her up on this offer but the T2D is here to stay.

[andreac]

This man is leveraging on his love for his mother(and of course on his knowledge) to help literally thousands of people. Just wonderful.

[bettesmith]

This was very helpful. I understand so much better now. Thank you very much!!!

[ThingsYoudontwanttohear]

You get my like for this video sir Gill. I am so done with these false dichotomies all over the internet. We are just feeding the algorithms this way instead of our minds.