The Influence of Statins on Glucose Tolerance and Incipient Diabetes

Statins are the cornerstone of dyslipidemia management, lowering lowdensity lipoprotein (LDL) cholesterol levels and substantially reducing the risk for cardiovascular disease (CVD). However, many patients on statins have CVD despite reductions in LDL cholesterol. Furthermore, the cooccurrence of dyslipidemia, type 2 diabetes, and hypertension is common. A considerable body of evidence demonstrates substantial benefits of statins in terms of reduction of major cardiovascular (CV) events, stroke, and mortality in patients with or without diabetes. Higher doses and more intensive (i.e. more potent at LDL reduction) statin therapy are more effective than lower doses in both improving lipid levels and reducing adverse CV events. However, statin therapy has been demonstrated to increase the risk for incident type 2 diabetes, more so at higher doses. Type 2 diabetes and the metabolic syndrome are strong, independent risk factors for CVD. As a result, the US Food and Drug Administration (FDA) has added an adverse warning to statin labels. Seven statins are approved by the FDA: simvastatin, lovastatin, fluvastatin, atorvastatin, rosuvastatin, pravastatin, and pitavastatin. This article aims to examine the differential metabolic effects among the various statins, the clinical evidence outlining the effect of statins on glucose tolerance, the results of recent meta-analyses on the risk for statins and incident diabetes and, finally, discuss how clinical data influences dyslipidemia management in patients with a high risk for type 2 diabetes.