Tuesday, January 10, 2012

"Statins worsen glucose control" The evening news

Statins worsen glucose control in people with diabetes was the message I heard on the evening news last night.
How about the rest of the story.

     I think they were referring to an article in Diabetes Med. Dec.12:dol: 10.1111/j.1464-5491x
     The effects of rosuvasatin and atorvastin on glycemic control in type 2 diabetes- The Corall study Results: ( copied from an article in Medscape )



Treatment with the highest dose of statins, i.e. atorvastatin 80 mg and rosuvastatin 40 mg at 18 weeks from baseline, was associated with increase in HbA(1c) levels; baseline 57 ± XX mmol/l (7.4 ± 1.0%) to 61 ± XX mmol/mol (7.7 ± 1.3%) (range 5.0-11.9) for atorvastatin (P = 0.003) and from baseline 60 ± XX mmol/mol (7.6 ± 1.0%) to 63 ± XX mmol/mol (7.9 ± 1.2%) (range 5.7-12.3) for rosuvastatin (P < 0.001). Mean fasting plasma glucose increased from baseline 8.7 ± 2.4 mmol/l to 9.5 ± 3.0 mmol/l upon treatment with atorvastatin 20 mg (P = 0.002) and 9.0 ± 3.0 mmol/l after treatment with 80 mg (not significant compared with baseline). The mean fasting plasma glucose did not change after treatment with rosuvastatin (9.1 ± 2.7 mmol/l at baseline, 8.9 ± 2.7 mmol/l with 10 mg, 9.4 ± 2.9 mmol/l with 40 mg).
Closer look:  Atorvastatin 80 mg and Rosuvastatin 40 mg increase A1c by 0.3 which is about a 9 mg/dl ( or 0.5 mm/l ) increase in average glucose and about a 6 mg/dl( 0.3 mm/l ) increase in Fasting glucose. These are minimal changes when you consider that the accuracy of your glucose meter may be plus or minus 20 %.The benefit from taking a small dose of statin for out ways any potential slight increase in glucose. See the CARDS
study below.  



 My comments ;
    This Corall study was done with the highest dose of statins that most people with type 2 diabetes will never need .
   Most people with type 2 diabetes have minimal increases in their LDL cholesterol , Triglycerides associated with lower HDL .
    My friend John Nelson, PA and I did a small observational type study on people with diabetes admitted  to Sacred Heart Hospital in Eugene , Oregon for a coronary bypass . We did this study to document our observation that most of the patients with diabetes admitted for a coronary bypass were not on a statin. We looked at 121 patients and found that only 37 ( 30 % ) were on a statin. Many of these people were just started on the statin after developing chest pain. 
The average lab values for all of the patients was;     A1c     7.58
                                                                             Cholesterol  190.6 mg/dl ( 5 mm/l )
                                                                              Triglycerides 256.6  mg/dl  ( 2.9 mm/l )
                                                                               HDL             34.9 mg/dl ( .91 mm/l )
                                                                               LDL              110 mg/dl ( 2.9 mm/l )
The take home message is that most of us will not need the high doses of statins used in The Corell study to reach our target goal.

 For example 10 mg of lipitor will reduce LDL cholesterol by about 38 mg/dl ( 1mm/l ) in most people.That dose is more than enough to get the average person with type 2 diabetes below 100 mg/dl (2.6 mm/l )and close to 70 mg/dl. (1.8 mm/l )

The CARDS ( Collaborative Atorvasatin  Diabetes Study ) demonstrated that 10 mg of lipitor (atorvastatin) in people with type 2 diabetes without know heart disease but with at least 1 risk factor could prevent  37 major vascular events (Heart attack and strokes) for each 1000 people treated for 4 years.
My favorite line from The CARDS study is, “The debate about whether all patients with type 2 diabetes warrant statin treatment should now focus on whether any patient can reliably be identified as sufficiently low risk for this safe, efficacious treatment to be withheld.” 

Calder, David (2010). The diabetes Office Visit (Kindle Locations 621-623). David Calder, MD. Kindle Edition. 
Have fun be smart and defeat diabetes .   David Calder,MD


  

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Your comments and questions are appreciated. David Calder,MD