This is an important issue.

Here's another recent study that shows similar results to those discussed, but in a population that has not been studied that much in regard to statins and diabetes: post-menopausal women. 

Statin Uee and Risk of Diabetes Millitus in Postmenopausal Women in the Women's Health Initiative

Annie L. Culver, BPharm; Ira S. Ockene, MD; Raji Balasubramanian, ScD; Barbara C. Olendzki, RD, MPH; Deidre M. Sepavich, MBA;Jean Wactawski-Wende, PhD; JoAnn E. Manson, MD, DrPH; Yongxia Qiao, MD; Simin Liu, MD, ScD; Philip A. Merriam, MSPH;Catherine Rahilly-Tierny, MD, MPH; Fridtjof Thomas, PhD; Jeffrey S. Berger, MD, MS; Judith K. Ockene, PhD, MEd, MA;J. David Curb, MD; Yunsheng Ma, MD, PhD 

Arch Intern Med. 2012;172(2):144-152. doi:10.1001/archinternmed.2011.625 

http://archinte.ama-assn.org/cgi/content/short/archinternmed.2011.625 

Hi, I'm 57, male, natural remedies didn't help lowering cholesterol and I was prescribed on simvastatin 20mg/day from February 2004. It regulated my all cholesterol values (total, HDL, LDL, triglycerides). I know it is not easy to come off statins ( it can cause rapid growth of cholesterol) but I'd like to get rid of them because of the risk of diabetes etc. How to do that and not to endanger my health does anyone know ?

1. The Statin anti-cholesterol mythology and the ?Cholesterol Hypothesis? is under attack. Clinical cardiology needs to re-evaluate its basic suppositions. This FDA warning will be a warring volley of the death nail in the statin industry. Understand that the ?Cholesterol Hypothesis? is the raison d'etre for modern medicine.

2. Atherosclerotic plaque is due to LDL, which is vulnerable to attack by smoking, glucose and other blood sugars, especially fructose.

3. Oxidized and glycated LDL particles become less efficient in delivering their contents to the cells. Thus, they stick around longer in the bloodstream, and the measured serum LDL level goes up.

4. Statins will decrease the plaque burden acutely, but do long term harm to the cells.

5. Statins are known to interfere with caveolin production. Less membrane cholesterol results in fewer lipid rafts, and this leads to impaired glucose uptake.

6. About a year on statins after an MI the risk benefit begins to disappear. Study show long-term treatment with statins caused a clinically silent but still definite damage to peripheral nerves when the treatment lasts longer than 2 years.

7. Statins do not address the basic problem plaque which is oxidized and glycolysis of LDL.

8. The skin produces cholesterol sulfate in large quantities when it is exposed to sunlight. The skin actually synthesizes sulfate-capturing energy from sunlight in the form of the sulfate molecule, thus acting as a solar-powered battery. The sulfate is then shipped to all the cells of the body, carried on the back of the cholesterol molecule.

9. Treatment of atherosclerotic is not statins. It is spend significant time outdoors; eat healthy, cholesterol-enriched, animal-based foods; eat fermented foods like yogurt and sour cream; eat foods rich in sulfur like onions and garlic. Also bath several time a week in Epsom salts, Magnesium sulfate.

Hi Dr. Topol,

Thank you for your comments and explaining the data for statins as a preventative against these new findings...it sure seems there are diminishing returns with respect to statin benefits and diabetes risk. I am a 46 year old male and have been on atorvastatin now for 15 + years to treat high cholesterol levels which is heriditary. Late in 2010 I was diagnosed with diabetes (type 1.5, I'm quite sensitive to insulin), yet I'm not aware of any family history around it. I have to wonder now if I am one of the 1:200 who have been affected by long term statin use. I'd be curious to know if there are any data out there that suggests discontinuing statin use may help improve glycemic control?

i think the issue is quite relevant and widens our vision regarding treating with low potential of CV events or single risk factor(except diabetes) with statins .

• Hi Eric,this is a very difficult topic to give just one answer to every one on primary prevention.The simplest would be 1.-if you have risk for DBT(family Hx,obesity etc) try hard with life habits correction and/or take very low statins dose.2.-if you have higher risk for vascular atherosclerosis(family Hx. of CAD,Stroke,high LDL that does not respond to life style changes etc)should consider statins at a regular dose to decrease colesterol levels significantly   3.-if you have both risks(noy unusual) each case should by analized by the physician.In my opinion this is a very important topic due a few reasons:high number of population at risk and to develop DBT is not a minor health problem.May be a virtual consortium to arrive to a more case specific answer,and also FU on evidence
• Liiana Grinfeld Md,PhD 

 

You are to be commended for taking such a brave medical stand in your:

"The data are clear: in primary prevention, when comparing the benefit in preventing heart attack, stroke, and death vs the risk of diabetes, the trade-off is very slim—and the dangers, very real."

This is the year atorvastatin goes off patent. Does that have any relationship to answer the question: Why now? Why not 5 to 10 years ago? Are we always to remain so far behind the curve on these larger patient risk tradeoff realities? 

From a different point of view; What percent of those patients who quit taking their prescribed statins (in general 30+%) how many are preventing themselves from becoming diabetic? 

Can we get more definitive data on current patterns of statin/diabetes for those who are on secondary prevention? 

Might certain statins also be linked to other medical issues such as causing Erectile Dysfunction Syndrome necessitating Viagra etc?

What about statins causing Gynecomastia?

Might we not need to rethink our risk trade off and side effects paradigms to bring them up to the level of better prevention rather than trying to close the barn door after significant damage has been done?

Drug development and manufacturing is no longer in the horse and buggy stage, the neither should be our evaluations and prescribing of new drugs. 

 

 

I totally agree with your assessments.  Risk/ benefits ratio is often overlooked or ignored, in our effort to "help" the patient.  Like several of the replies, I have taken a statin for 20+ years, and developed diabetes 5 years ago.  I feel I am low risk otherwise.  If you remember, even the risk of exercise had "adverse" effect on me as well,  but I would never advise others to avoid exercise, just don't use their "head" as a "air bag for a fall like me.

Statins have long been known to mediate cholesterol ,but they also have had some disadventages if you taken them long term,when you just have had high cholesterol  Change lifestyle is the best solution such as regularly exercise and taking healthy diet,which are the cornerstones to prevent increase cholesterol levels that can trigger several diseases

Now after about two years on 40 of Lipitor my numbers are very good 53 LDL 70 HDL but I am also a 100 mile a week Runner and at 55 YO running sub 19 min 5ks. Had high LDL and was reluctant to take a Statin for many years from age 40 or so when I did my initial lipid testing. Blood glucose levels have been in the High 70s to mid 90s during this time . My last Fasting  blood work a BG of 97?? I am on a very good vegatarian diet,  I have a call in to my Physician about a lower dose of the statin..My ultimate thought here is my last bloodwork . A year ago fasting glucose was 83 now 1 year later 97 , sure it is in the normal range but still not feeling comfortable with these new studi

Allen - Consider eliminating statin and rely on more meaningful lipid test measurements than LDL.  Lipid specialists know that HDL, ApoA/B ratios and particle counts are truly the significant indicators of risk, not LDL.  Huge bias exists in most of the medical community when a patient tries to eliminate statins and use your lifestyle (exercise/nutrition) as your therepy.  Yet, your lifestyle delivers what meds cannot - a functional HDL system that is keeping your lipid metabolism in high working order.   Most doctors refuse to put the same weight on LS as a true therapy approach and view meds as more legitimate/serious program.  Partly because most patients fail at LS changes.  Use your superior LS behavior to your advantage, dump the statin and start measuring the true indicators of risk.  The human body, given decent LS behaviors, delivers more benefits and lowers risks of CVD, than statins can any day.  Trust the LS you have as your best medicine.

I have had the LippoProtein tests all numbers are in the great range. Heck even Trys are 36. My particle counts were bad before Lipitor Way too many LDL particles. Yes lipitor sure helped but I did change my diet BIG TIME. I have called doc to see if we could reduce Lipitor to say 20 per day or even 10 I will then see what happens to numbers by august.There is a poor history of heart disease in my family. Father has had two bypass and is still alive at 81 and has been on statins for 25+ years. His first heart event in his late 40s. Thanks for your response.

Allen - I'm not a MD, just a 57 yr old CVD patient who spent 2 yrs in SATURN study with heavy statin doses for 2 yrs.  Completely change LS with diet and started running 20-25mi/wk, losing 50 lbs, 36 resting HR, 110/55 BP and HDL from 39 to 60s.  Against every MD's recommendation, I stopped statins at end of study.  Then statin free, proved LS was delivering the lipid readings showing lowest possible risk.  Also have family CVD history but those deceased had poor LS behaviors. Very little within medical communities will encourage you to try a statin free approach and rely on your in place healthy/fitness program.  System is skewed to show statins are giving your body advantages when your own LS may be already delivering a lowest risk situation.  I wanted to KNOW if statins, OR LS, was delivering advantages on lipid measurements.  So I quit the statins, kept religious on high standard LS behaviors and learned that LS are, alone, delivering low risk. Check out Allan Sniderman MD for best expertise on what's important for lipid readings.  The high LDL scores simply are not telling compared to ApoA/B. Raising your HDL via exercise is better than pills in a bottle because these are called functional HDL advantages.   It's hard to find MDs that appreciate your exercise LS as a full fledged substitute for statins.  I'm not anti drug companies - just anti the bias that statins are the one and only therapy for lowering CVD risk - it simply isn't supported in science vs LS doesn't have the same funding behind it showing it as a lifetime solution.  I seek the truth in managing CVD risk and find the medical community landscape saturated with pro med solutions for everything.  Yet, serious exercise and nutrition plans are more potent and sustainable solutions - they aren't adopted by most patients and partly because MDs almost must prescribe statins or face malpractice given the national standards on LDL - it puts patients like you and me at a disadvantage.  Best wishes with your plans.

Hopefully we will get CETP inhibitors sooner than 2017

"the tradeoffs are narrow and this is a big deal"

 

Time to abandon biomarkers (in this case glucose).  I could not more vociferously disagree with the implication that statin use should be restricted due to a 1/200 increased risk of glucose intolerance. "Diabetes avoidance" should not be a goal trumping prevention of cardiovascular adverse outcomes. If a trial sufficiently powered and randomized showed an increased incidence of glucose intolerance but less adverse cardiovascular events would you abandon that therapy based on the laboratory analysis of a failed biomarker?  That would cause you to abandon the only antihypertensive to extend lifespan (chlorthalidone) and the beta blocker with greatest anti-anginal effect (atenolol).  And in ACCORD what had a greater effect on prognosis - glycemic control or statins?  I think we need to be very careful here.  When the margins are narrow but favor therapy in hard endpoint reduction we usually trumpet this as a gtreat success.  In this argument there is a small benefit but an abnormal lab (maybe not randomized replicated data) and so we abandon the benefit?  I am not sure I follow the reasoning here.  Finally if glucose intolerane/diabets was diagnosed with a 0.5-0.8% greater frequency yet carried no consquences what really is the argument? Doesn't seem like a big deal with the strength of the data at this point.

It is a challenge for physicians and patients to make definitive decisions with conflicting results from competent studies and opinions.  Despite many years of regular strengh training exercise and following good dietary guidelines my HDL stays in the high 20's range.  A year ago, my physician added 40mg of Simvastatin daily and after 12 months, it is now 31.  I wonder, do I switch to another Statin, go off the Simvastatin or do something else.  

Please do not substitute this for the advice of your physician.

Having a similar diagnosis of familial dyslipidemia I would advise high dose statin and forget about the numbers.  The notion of biomarker guided event reduction has never been proven to have any value aside from highest tolerable dose statin therapy and combination therapy has been tested and thus far has not been additive (niacin and fenofibrate).  CTEP inhibitors may be of assistance but that is under study. For all the deserved criticism that interventional cardiology has received the real scam artists are the interventional lipidologists - however well meaning the data just isn't there.

It was great to get data translated into simple, easy to understand numbers.

In my practice, the numbers mean that I have to be more vigilant and more expressive and thorough with patients about encouraging and monitoring nutrition and lifestyle change, not just prescribing statins. Statins, I believe, are very, very useful, and MUST BE part of a whole picture effort in helping people change their risk profile to get healthier outcomes.

Has anybody looked at whether the risk of diabetes with statins applies to people with elevated BMI?

Has anybody looked if the risk of diabetes with statins applies to vegans or those who avoid food products from cows?

There needs to be some additional data mined if possible, as medicine begins to financially (finally) incentivize healthy nutrition and lifestyle with medication used as necessary.

Thank you for your efforts,

Harvey Zarren, M.D.

Dr Topol,

 Thanks for your insightful comments on this topic. What a game changer ! This is going to dramatically change practice patterns in primary prevention. It seems that very little is better than regular physical activity and healthy eating habits. Perhaps we should invest more of our resources in preventing the epidemic of obesity esp. in children, as far as primary prevention goes. That and tobacco cessation ultimately will save tens of thousand more lives than statins it appears!

I hope you are well. 

your former fellow,

Ryan 

 

Under attack?? you mean effectively destroyed. How many scientific references do you want? Give me one, just one study in which the positive effects could not be achieved with an NSAD and extra Vitamin D plus a reduction in carbohydrate intake combined with a reduction in N6. I have not recommended any statin therapy for at least 7 years, and nobody appears to the worse for it. Added benefit they are all still walking. Unassisted! Yours too??

Mark - Please read about FUNCTIONAL HDL and how exercise can raise it.  My experience, and the research, showed that regular, rigorous cardio - you have to sweat - delivers higher HDL numbers.  But more important, the HDL system is working more effectively for cardiac protection on the lipid (fat deposits) front.  Strength training is healthy, no doubt, but doesn't deliver the same impact on the HDL raising as cardio training.  Even swift, rigorous walking can deliver pure cardio training.  Many ways to measure when cardio training is taking place, but my lay person measure is that sweating confirms, to most people, that a high enough level of cardio is taking place.  I used walking to lose 50 lbs over one year.  And continued cardio 3-4 times per week to get ApoB measures down to protective levels.  Of course, nutrition plans are critical also.  But it's the cardio action that delivers higher and FUNCTIONAL HDL levels.  Something that statins cannot deliver with the same effectiveness.  Find some cardio activity you actually enjoy (swim, walk, jog, ski, etc) and it becomes sustainable.  Taking statins is easy to prescribe by Drs and easy to accept by patients and it all sounds effective.  But the human body WILL deliver the functional HDL system you desire, without statins, if the heart is allowed to be exercised - which is why the cardio activities become important.  Good luck!  - Bill

another drug huh? do you work for a pharmaceutical company?

Actually I am a physician treating individuals with extreme dyslipidemias and rapidly advancing atherosclerosis,

I have no drug company connections.

CETP inhibitors will probably solve many difficulties associated with statins by enhancing reverse cholesterol transport.

This may allow many young children and adults to suspend LDL apheresis and live productive lives despite their genomic anomalies. 

It is refreshing to hear a non-biased review of these problematic drugs. The increased risk of diabetes in statin users is cause for great concern.

Barbara Roberts, MD

I will try the higher intensity cardio route and maintain the 40 mg of Simvastatin and see if things change in a few months.  If so, I don't know what to do because another comment suggests that I increase my statin intake.  I have also been told to switch to Crestor which has both HDL/LDL benefits.  As I initially stated, well intentioned people are giving me well intentioned yet conflicting advice.     

Statins show very little benefit in primary prevention, with large increases in rates of diabetes. Talk w/your Dr. http://blogs.theheart.org/topolog/2012/3/1/statins-and-diabetes-a-hard-look-at-the-data-2 

Huh???  A doctor prescribes statins and then, one is told to ask his/her doctor if statins cause diabetes or are safe.  Doctors are trained and indoctrinated to write prescriptions and cut out body parts. That is how they make a living.  So, do you think they will risk losing their income.  The best way to take care of your health is Mind, Body Spirit health.  See a Naturopath who doesn't prescribe pharmeceuticals. See a Holistic Health Care practitioner and attend to your spiritual needs vis-a-vis NON-religious venues.  

The issue of effectiveness of reducing LDL with a statin for primary prevention of coronary events is unresolved.  The mean age of participants enrolled in the statin trials was 63 years.  This means that treatment with a statin in these groups was being used to merely stabilize the underlying atherosclerotic burden. We need trials of long term reductions with statin or other therapies to reduce LDL to determine if preventing (rather than treating) coronary atherosclerosis is possible.  I wonder what the ACC.12 Late Breaker on "Mendelian" randomized trial of lowering LDL early in life is all about?

High cholesterol is not a disease but a consequence of a high glycemic diet. Prescribing statins makes as much sense as prescribing Provigil to a drunk. Drs have been led along by drug companies to continue this "pill for every ill" model that has us as one of the leading causes of death in the U.S. See "Is U.S. Medicine the Best Medicne" by Barbara Starfield M.D. MPH in JAMA.

High cholesterol is a consequence of low thyroid function,too much grains/sugar in your diet or a combination of both.Its not a disease. Lab test will not usually reveal the low thyroid issue as pointed out years ago by endocrinologist Broda Barnes MD after 30 years of research. Get off rice,corn,and wheat. Find a Dr willing to do a comprehensive history and physical looking for evedence of low thyroid. Get book "Hypothyroidism Type 2" by Mark Starr M.D. 

Also,take a look at the work of Broda Barnes M.D. These patients usually have undetected hypothyroidism.

Thank you.

High cholesterol is never "hereditary". Either you have too many grains/sugar in your diet,you have hypothyroidism,or both. You at least have hypothyroidism as that is what causes type 2 diabetes. Get book "Hypothyroidism Type 2" by Mark Starr MD and look at YouTube videos by DeWayne McCulley on YouTube. Even as a physician,I had to find this all out after being diagnosed myself.

Would it not be the simplest thing to prescribe a modest does of a Statin and, shoudl that not prove sufficient, then provide niacin or other medication(drug or spplement) in addition, particularly for primary use?  I speak as a lay non-statin induced, well controlled diabetic who takes 20mg of Lipitor and has LDL readings  regularly of between 70 and 80.  

 

Very instructive for every Dr to read "How we Do Harm" by oncologist and Chief Medical Officer of the American Cancer Society, Otis Brawley M.D. Things have gone very wrong in medicine. Statins are a symptom of a much bigger problem.

 

To those who are trying to find an alternative to statin drugs I recommend you go to the study called Fiber-Multivitamin Combination Therapy-A bneficial Influence On Low-Density Lipoprotein And Homocysteine by Dennis L. Sprecher and Gregory L. Pearce in 

I am negatively impressed by the emotion and firm conviction in Dr. Topol's comments.  The studies cited show statistical association and not causation.  The statistics are true only if they are free of hidden bias and implied assumptions are valid.  The findings are clearly of concern but it is premature to use such terms as "statin induced diabetes."  I think a more valid statement is that only a very small percentage of the population benefits from statin use in primary prevention despite considerable cost and risk of side effects.

Dear Topol,

what are the mechanisms associated to diabete induced by statins?

In Eric Topol’s book ‘The Creative Destruction of Medicine’ my question is how will Cardiology-Medicine continue to exist?  The Cholesterol-Statin Hypothesis seems to be a terrible lie. The medical-pharm establishment has probably been fatally wounded.

 

How will society trust the prolonging of health and the development of new treatments based to money rather than improving the health of the species?  The foods sold in the modern supermarket are terribly flawed.  The ramped obesity and autoimmunity is diet not genes. 

 

Human disease, especially auto-immune problems is more related to diet, the human genome is stable for 50,000 years.

 

The Paleo Diet concept in about 1985 by Dr. Boyd Eaton’s seminal New England Journal of Medicine paper, Paleolithic Nutrition the genome is not the problem.

 

Hi!. There are another interesting point of view of other recent meta-analysis: http://www.cmaj.ca/content/183/16/E1189
And my particular point of view is here (in spanish): http://medicablogs.diariomedico.com/santos/2012/04/15/estatinas-de-la-discordia/

Dr. Topol:

I was impressed with your analysis of the statin literature and appreciate your taking the time to present your assessment. Is a transscript of your video presentation available? 

By the way, a Google search turned up some of the high-profile, courageous and inspiring positions you have taken in the past on other pharmaceutical issues. I find your decision to place your esteemed professional position at risk by serving as an unrelenting advocate for patient safety truly remarkable and commendable.  Quite an inspiring story sir...a story more laudatory than your incredible publication record in my humble opinion! 

Lewis

I am genuinely appreciatve of the 40+ comments here, which I think sets a new record for this video blog over the 5 years since it started!

For anyone who questions whether the risk of diabetes is real or that there is lack of a cause and effect story, I guess there will never be a data set that will be adeqautely convincing.

Especially grateful to Lewis Watts, above, for his exceptionally kind perspective.

I think I am witnessing the ‘destruction’ of the American population by food poisoning.  Your own history with the power of the Pharmaceutical Industry is sobering. I read your book, but I also benefited by Dick Hill audible version on my Kindle.

 

As discussed in your book: The VA’s Vista and DOD are working on ‘BLUE BUTTON’ databases for patients to manage their data.  

what about people with low diabetes risk
as per the data submitted, in people with low risk of diabetes there was NO increased incidence of new diabetes in the JUPITER trial. hence in clinical practice when we juggle around with the trade offs, it may help to consider a person's risk of CHD versus new onset diabetes.