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Statins & Diabetes. A Step-by-Step Guide

Do Statins cause Diabetes? What factors determine diabetes risk on a statin and how can we avoid it? A step-by-step guide to statin use and diabetes risk Part II of the statin series focuses on diabetes. In some trials statins raise risk of diabetes, in others statins have no significant effect, in others statins lower risk of diabetes. some meta-analyses find statins raise risk of diabetes, others find no significant effect of statins on risk of diabetes. risk of diabetes on a statin are determined by diabetes risk factors, statin dose and statin type. people with risk factors for diabetes (obesity, Metabolic syndrome, pre diabetes; fasting glucose or glycated hemoglobin above normal but not in diabetic range), statins reduce cardiovascular risk (heart attacks, strokes) but increase risk of diabetes. For people without diabetes risk factors, statin reduces cardiovascular outcomes with no significant increase in diabetes risk risk of diabetes on a statin mainly a concern for people already at risk of diabetes; both with and without diabetes risk factors the benefits of the statin outweigh the risks “cardiovascular and mortality benefits of statin exceed diabetes hazard, including among those at higher risk for developing diabetes” absolute terms: 2 cardiovascular events avoided per new case of diabetes, in people at higher risk of diabetes Some statins raise diabetes risk, some don't. e.g. Pravastatin and pitavastatin talking to a cardiologist I would factor in diabetes risk factors, consider lower dose or a statin that doesn´t raise risk and follow fasting glucose and HbA1c, glycated hemoglobin why do some statins raise risk of diabetes? they may raise BMI which raises insulin resistance & diabetes. maintaining healthy body weight via diet and exercise while on a statin may lower risk Sometimes people claim statins double risk of diabetes based on observational studies. when adjusted, the effect is cut in half and fasting blood glucose becomes non significant. Also, the effect differed by statin type, it was strongest with atorvastatin and not significant with most other statins like pravastatin or pitavastatin most long observational studies show a diabetes risk of atorvastatin and rosuvastatin, while pravastatin and pitavastatin show no significant effect based on this, I would assess diabetes risk factors, obesity, pre-diabetes, i´d lean toward statins that don´t increase risk, e.g. pravastatin or pitavastatin, If we need atorvastatin or rosuvastatin, i´d favor moderate dose. If it doesnt bring cholesterol down enough, i´d rather add ezetimibe or pcsk9 inhibitors rather than crank up statin dose. and keep an eye on glycemia and keep lifestyle healthy Connect with me: Facebook:   / drgilcarvalho   Twitter:   / nutritionmades3   Animations: Even Topland @toplandmedia References: https://www.nejm.org/doi/full/10.1056... https://diabetesjournals.org/care/art... https://www.ahajournals.org/doi/full/... https://onlinelibrary.wiley.com/doi/p... http://plaza.umin.ac.jp/~juku-PT/phar... https://www.bmj.com/content/bmj/374/b... https://jamanetwork.com/journals/jama... https://www.ncbi.nlm.nih.gov/pmc/arti... https://www.ncbi.nlm.nih.gov/pmc/arti... https://www.sciencedirect.com/science... https://jamanetwork.com/journals/jama... https://www.thelancet.com/journals/la... https://www.ahajournals.org/doi/epdf/... https://www.sciencedirect.com/science... https://care.diabetesjournals.org/con... https://link.springer.com/article/10.... https://cardiab.biomedcentral.com/art... https://academic.oup.com/eurheartj/ar... Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!. #NutritionMadeSimple #GilCarvalho 0:00 Introduction 0:52 Disclaimer 1:20 The setup 3:12 Statins & Diabetes risk 5:24 Diabetes risk factors 10:39 Statin dose 12:53 Statin types 15:24 Putting them together 16:46 Mechanisms 17:20 Observational evidence 20:08 Funding 20:52 Summary 22:24 Importance of information quality