Taking Statins When You Have Diabetes

Statins are a type of medication used to lower cholesterol. As part of your regular diabetes care, your healthcare provider will usually order blood tests to check for different metabolic abnormalities.

If your cholesterol is high, your healthcare provider may prescribe a statin as part of your healthcare regimen. They will help you weigh the risks and benefits of taking the medication to guide you in making the best decision for your health.

How Does Diabetes Affect Cholesterol?

Not only does diabetes affect your blood glucose levels, but it can also affect your cholesterol levels. Diabetes can lower HDL “good” cholesterol levels while increasing LDL “bad” cholesterol and triglyceride levels. This is called diabetic dyslipidemia, meaning your blood cholesterol results are going in the wrong direction.

Diabetic dyslipidemia can raise your risk for atherosclerosis, heart disease, and stroke. Research suggests an association between insulin resistance and diabetic dyslipidemia. Associations are also seen for atherosclerosis and blood vessel disease.

Insulin resistance occurs when your muscle, fat, and liver cells don’t respond well to insulin and can’t easily remove glucose from your blood. Insulin resistance often begins well before type 2 diabetes is diagnosed. Thus, associated cardiovascular conditions can develop even before you have diabetes.

The American Diabetes Association (ADA) recommends routine screenings for type 2 diabetes for everyone every three years after age 35, and more frequently if symptoms develop or risks change (i.e., weight gain). Routine screenings may be recommended by your healthcare provider if you're under 35 but have certain high-risk factors, like being overweight or obese, a family history of the disease, heart disease, high blood pressure, a history of gestational diabetes, and/or a sedentary lifestyle.

Taking Statins With Diabetes

Statins work to lower cholesterol levels by blocking a substance your body needs to make cholesterol, therefore decreasing cholesterol made in your liver. They also help lower triglycerides and raise HDL “good” cholesterol.

Besides improving cholesterol, statins are also associated with a lower risk of heart disease and stroke, which are common comorbidities in diabetes.  

People with diabetes are twice as likely to have heart disease or a stroke compared to someone who doesn’t have diabetes—and at a younger age. The risk for developing heart disease increases the longer you have diabetes.

This is because, over time, high blood glucose levels cause damage to your blood vessels. This damage can obstruct the blood flow to your heart and brain, raising the risk of a stroke or heart attack.

Because of this increased risk, the ADA and the American Heart Association (AHA) recommend statin therapy in addition to lifestyle changes for the prevention of cardiovascular disease in people with diabetes, regardless of cholesterol numbers.

Depending on age, disease status, and other risk factors, the ADA suggests differing intensity levels of statin therapy.

There are other risk factors for heart disease that can also be treated or modified. By doing so, your overall chances of developing heart disease may decrease. These risk factors include:

• High cholesterol
• High blood pressure
• Being overweight or obese
• Smoking
• Heavy alcohol consumption
• Diet lacking in nutrient-rich foods
• Physical inactivity
• Stress

Do Statins Increase Blood Sugar?

Some research suggests that statin use increases blood sugar levels. A 2019 study published in Diabetes Metabolism Research and Reviews reported that statin users had a higher risk of developing new-onset type 2 diabetes. The risk increased the longer you took statins, with the greatest being in people taking statins for two years or longer.

Research published in Cardiovascular Diabetology also found an association between statin use and a significantly increased risk of new-onset type 2 diabetes. Researchers noted a dose–response relationship, suggesting that a longer duration of statin use increased the risk even more.  

Furthermore, the Women’s Health Initiative study found that statin use increased the risk of diabetes in people after menopause. This large study mentioned that the increased risk appears to be a medication class effect, unrelated to dose or individual type of statin.

Due to the research and studies published regarding this risk, the Food and Drug Administration added a warning on statin labels to reflect the increased risk of higher blood sugar levels and new-onset diabetes when using statins.

Despite this increased risk, statin use is still indicated in many people with diabetes. This is because the decreased risk for stroke and heart attack outweighs the risk of higher blood sugars. Further, people who already have diabetes are not going to have diabetes caused by statins, because the diabetes already exists.

Nevertheless, always discuss with your healthcare professional the risks and benefits of taking statins as they relate to your individual risk factors and disease status.

What Statin Should You Take?

Your healthcare professional will take into account several factors when prescribing a statin. These include your cholesterol levels, risk factors you might have for heart disease, and your individual tolerance of the specific medication.

There are several statin medications, each with differing potency and dosage levels. As mentioned previously, the ADA recommends different intensity levels of statin therapy for people with diabetes, usually a moderate- or high-intensity statin.

Moderate-Intensity Statins

How well you tolerate a statin is an essential factor when choosing which statin to prescribe. Depending on your healthcare provider, they might start with a moderate-intensity statin and increase intensity later if your cholesterol levels do not improve enough.

The following moderate-intensity statins can reduce your LDL by 30% to 49%:

• Lipitor (atorvastatin) 10 to 20 milligrams (mg)
• Crestor (rosuvastatin) 5 to 10 mg
• Zocor (simvastatin) 20 to 40 mg
• Pravachol (pravastatin) 40 to 80 mg
• Altoprev (lovastatin) 40 mg
• Lescol XL (fluvastatin) 80 mg
• Livalo (pitavastatin) 1 to 4 mg

High-Intensity Statins

Alternatively, they may opt to start with a higher potency statin, then adjust the type of statin or lower your dosage if it is not well tolerated.

High-intensity statins can lower your LDL cholesterol by 50% or more. If your cholesterol is especially high, or you have several cardiovascular risk factors, your healthcare provider may prescribe one of the following high-intensity statins:

• Lipitor (atorvastatin) 40 to 80 mg
• Crestor (rosuvastatin) 20 to 40 mg

Low-intensity statin therapy in people with diabetes is usually only recommended by the ADA when high-intensity therapy is not well tolerated.

Summary

If you are concerned about taking a statin, talk with your healthcare provider about the pros and cons. They will help you weigh the risks and benefits as they relate to you. The benefit of preventing a heart attack or stroke often far outweighs the possible risks and side effects of statins. Never stop taking a statin without discussing it with your healthcare provider first.

Maintaining healthy cholesterol and blood glucose levels is important to decrease your risk of heart disease. Medication alone is not enough to curb your overall risk, though.

Lifestyle changes, including quitting smoking, following a healthy eating pattern, and being physically active, are also critical in reducing cholesterol levels and managing diabetes. Together, medication and healthy lifestyle habits can help you decrease your risk of developing heart disease while enjoying a great quality of life.