Life is full of trade-offs. One alarming one is that statins, drugs intended to lower unhealthy cholesterol levels and boost healthy cholesterol, thereby reducing the risk of heart disease, seem to raise the risk of type 2 diabetes. Obesity is associated with both high cholesterol and diabetes, but the drug itself seems to raise diabetes risk. In some studies, the risk of diabetes went up as much as 32 percent due to statin use, even as heart disease fell 44 percent. In part because of the obesity link, this side effect is a danger to the 13 million people expected to be on statins, some of the most widely prescribed medications in the world, during their lifetimes. Fortunately, researchers think they may have come up with a way to minimize this effect.
Statin drugs have come under fire recently for perceived over-prescription. Given the consistently high effectiveness of the drugs—lowering heart attack and stroke risk as much as 40 percent—and particularly given the side effects, there is some concern that people are being given statin prescriptions as a one-size-fits-all quick fix when they may be better served by some other approach. The side effects, though rare, can be dangerous or even fatal. In addition to type 2 diabetes, statin users can suffer memory loss, liver damage, and muscle weakness. In some cases, statins can lead to a potentially fatal condition of severe muscle pain, liver damage, and kidney failure called rhabdomyolysis. In light of these dangers, some experts are wary of prescribing these drugs to patients who do not have a high risk of heart disease. Patients who have not had a heart attack, or who do not already have high cholesterol, are unlikely to see enough benefit from statin drugs to offset these risks.
However, at least for diabetes, the risk may be easily manageable. The effect of statin drugs involves an immune response, which is how they achieve their cholesterol-lowering feats. However, another effect of this immune response is to target the pancreas and lower insulin levels, leading to elevated blood sugar. The immediate recommendation is a second drug, called glyburide, which protects the pancreas from this immune response, and helps maintain the production of the needed amount of insulin. The researchers say further investigation of the immune response is needed to find ways to prevent or counteract other side effects.