All statins increase risk of diabetes
Dear Dr. Roach: I’m 62 with a family history of coronary artery disease. I have mildly high LDL cholesterol level, and my 10year risk of heart disease is 26% considering my treated high blood pressure. I was on Crestor, but I read that it can increase the risk of diabetes. I changed to Lipitor, but then read that lipophilic statins increase dementia risk (which runs in my family). Pravastatin is the only hydrophilic statin left — should I switch to that?
M.S.
Answer: With your high risk of developing a heart attack or stroke, treatment with a statin is clearly indicated. This should be in addition to lifestyle changes. Dietary changes and regular moderate exercise have large benefits in preventing heart disease, in addition to many other benefits.
All statins increase the risk of developing diabetes. The relative risk is estimated to be about 10%. Put another way, treating 1,000 people with high-dose statin would be expected to cause five to 10 new cases of diabetes. It is thought that diabetes will occur in people who have genetic risk for diabetes.
Hydrophilic and lipophilic are terms that refer to a drug’s ability to dissolve. Hydrophilic drugs dissolve in water, while lipophilic drugs are fat-soluble. A new study looking at reports of memory loss associated with statins found that it is more commonly reported in people taking lipophilic statins than hydrophilic statins.
In the case of memory loss after statin, switching to a different statin, preferably hydrophilic, is a reasonable strategy, as often this can reverse the memory issue. Simvastatin (Zocor), atorvastatin (Lipitor), lovastatin (Mevacor), fluvastatin (Leschol) and pitavastatin (Livalo) are lipophilic statins. Pravastatin (Pravachol) and rosuvastatin (Crestor) are hydrophilic.
Large studies have shown that neither lipophilic nor hydrophilic statins increase in the risk of developing Alzheimer’s dementia, and some studies have shown a reduction in the risk of developing dementia. I suspect there are some people who have a medication reaction to statins causing memory loss, but statins overall do not hurt and may help prevent dementia, perhaps by preventing small strokes.