Statins and Diabetes: 6 Myths

If you live with diabetes and your doctor has recommended a statin to reduce your risk of heart disease, you may be feeling anxious about adding a new medication. Learn the facts behind these six common statin myths.

chalk heart on sidewalk with feet (Photo: Unsplash, Guilame Lorraine)

 

Myth #1: Statins Cause Muscle Pain

The most common side effect of statin use is muscle pain and cramping, with around 10% of patients reporting this, says Robert Eckel, MD professor of medicine in the Divisions of Endocrinology, Metabolism and Diabetes, and Cardiology at the School of Medicine at the University of Colorado.

Some symptoms can go away as you take the statin, and even if they don’t, you may be able to improve statin-related muscle pain with exercise. But you don't need to run a marathon. A little gentle stretching may be all that's needed to relieve muscle cramps. Never begin a new exercise routine with a vigorous plan. It's best to start with slowly—walking or beginner's yoga is ideal—and move everyday.1

While a small number of individuals who take statins experience mild muscular discomfort, the vast majority don’t have any discomfort, says Prakash Deedwania, MD, FACC, FAHA, FESC, a professor of medicine at UCSF School of Medicine in San Francisco. “The pain has nothing to do with muscle damage,” Dr. Deedwania adds. “And the benefit from the statin is far greater than any discomfort the person may have.”

It’s unusual for statins to cause muscle damage, says Johanna Contreras, MD, Director of Heart Failure at Mount Sinai St. Luke’s Hospital in New York City. “However, it is important to be aware of symptoms and to let your doctor know about  any pain,” she says. “If you have discomfort, you will likely be instructed to have your muscle enzymes checked within six weeks to see if you might be getting myalgia (myalgia is the medical term for pain), from inflammation of the muscle which can be easily treated with rest and sometimes OTC pain medication such as ibuprofen.”

Myth #2: Statins are Not Advisable for Older Adults or Diabetics

“If you have diabetes, or high cholesterol, or if you have coronary artery disease you should definitely take a statin,” Dr. Friedman says explaining that statins are now recommended for those who have cardiovascular disease and for individuals between the ages 40 to 75 who don't have cardiovascular disease but who do have at least one risk factor (high blood pressure, high cholesterol, diabetes, or smoking) and a 7.5% or greater risk of a stroke or heart attack in the next decade. 

Some research indicates that statins may benefit people over 75 as well, Dr. Friedman adds.

With regards to people with type 2 diabetes, Jennifer Mierdes, MD, FACC, MASNC, FAHA says the evidence is overwhelming that statins benefit the heart. "We know that diabetes is such a potent risk factor for heart disease that in terms of stopping the progression of disease and stabilizing the plaque, statins should absolutely be considered.”

Myth #3: Statins Raise Blood Sugar

Statins in very high doses may cause some abnormality in the blood sugar, Dr. Deedwania admits. 

“If you have metabolic syndrome, then you may be at a mild risk for this but it happens to a very small percentage of people,” he explains. “We have done a lot of analysis, which shows that the benefits from the statin far outweigh the risk.”

 

One study concluded that when it came to blood sugar and taking statins, causality could not be established. “From a clinical standpoint, there is currently no evidence that elevations in blood glucose while taking lipid-lowering drugs are associated with an increased risk of cardiovascular events or that they attenuate the beneficial effects of the therapy,” the authors of the study noted.

They added that until further study was conducted, statins “should continue to be used based on a careful assessment of risk and benefit.” 2,3

Myth #4: Statins Cause Dementia

Some data suggest that statins could lead to cognitive deficits, but this has not been borne out in large-scale trials, says David Friedman, MD, Chief of Heart Failure Services at Northwell Health’s Long Island Jewish Valley Stream Hospital in Valley Stream, New York. “We are talking a very small number of people,” he says. “Most people who are told to take a statin by their doctor  should take it.” To help prevent any cognitive deficits, he recommends staying “active and involved in your community.”

When John Hopkins researchers reviewed dozens of studies on the use of statin medications, they found that the most commonly-prescribed statins posed no threat to short-term memory and that they may even protect against dementia when taken for more than a year.

The authors concluded: “In patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data may support a beneficial role for statins in the prevention of dementia.” 4

Myth #5:  Statins Cause Cataracts

“There is no unequivocal evidence that statins cause cataracts,” Dr. Deedwania says. “The best way to protect your eyes from cataracts is to wear UV protective sunglasses. You also may reduce your risk of cataracts by controlling your blood glucose.”

Moreover, statins may actually be good for your eyes! In one recent study on the association of statin therapy with the development of diabetic retinopathy in individuals with type 2 diabetes and high cholesterol, the researchers found that statin therapy was linked with a decreased risk of diabetic retinopathy and the need for treatment for this vision-threatening condition.5,6

Myth #6: Statin Users Should Never Drink Grapefruit Juice

While this may be a myth, it’s generally understood that “excessive amounts of grapefruit juice (over 8 ounces) can have significant effects and interactions with the statin, particularly if the grapefruit juice is taken simultaneously with the statin,” says Dr. Deedwania. “Drinking grapefruit juice changes the levels of the statin in the blood.” 

Timing needs to be taken into consideration since grapefruit juice increases the levels of the statin and the overall muscle toxicity of the statin, he says.7

Could there be any benefit to drinking grapefruit juice while on a statin in order to reduce “bad” cholesterol? “This is not advisable because the benefit is not measurable in every case,” Dr. Deedwania says.

 

Updated on: July 8, 2019
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