Is Simvastatin Used For Diabetes

Do Statins Increase Blood Sugar

Some research suggests that statin use increases blood sugar levels. A 2019 study published in Diabetes Metabolism Research and Reviews reported that statin users had a higher risk of developing new-onset type 2 diabetes. The risk increased the longer you took statins, with the greatest being in people taking statins for two years or longer.

Research published in Cardiovascular Diabetology also found an association between statin use and a significantly increased risk of new-onset type 2 diabetes. Researchers noted a doseresponse relationship, suggesting that a longer duration of statin use increased the risk even more.

Furthermore, the Womens Health Initiative study found that statin use increased the risk of diabetes in people after menopause. This large study mentioned that the increased risk appears to be a medication class effect, unrelated to dose or individual type of statin.

Due to the research and studies published regarding this risk, the Food and Drug Administration added a warning on statin labels to reflect the increased risk of higher blood sugar levels and new-onset diabetes when using statins.

Despite this increased risk, statin use is still indicated in many people with diabetes. This is because the decreased risk for stroke and heart attack outweighs the risk of higher blood sugars. Further, people who already have diabetes are not going to have diabetes caused by statins, because the diabetes already exists.

When Are Statins Typically Recommended

Statins are prescription medications that lower levels of LDL cholesterol in the blood. They do this by reducing how much cholesterol is produced and by helping the liver remove cholesterol from the blood.

This isnt the only benefit of statins, though. They also have anti-inflammatory effects and protect blood vessel walls from damage. A review of several studies shows that statin therapy not only reduces cholesterol, but also the risk of heart disease, stroke, and even death.

As such, a statin is usually recommended for adults with high levels of LDL cholesterol. You may see some recommendations saying that the cutoff is 190 mg/dL of LDL cholesterol in the blood, but the decision to start statin therapy is usually based on many additional considerations, including other risk factors you may have for cardiovascular disease. Other risk factors can include:

• Smoking

• Having a family member who has or has had cardiovascular disease

• High blood pressure

• Gender

• Being overweight or obese

Currently, the American Heart Association, American College of Cardiology, and the American Diabetes Association recommend that all adults ages 40 to 75 who have type 2 diabetes should take a statin to prevent cardiovascular disease related to atherosclerosis.

Mechanisms Of Metformins Action In The Liver

Metformin navigates to the liver via the portal vein and is taken up predominantly by OCT1 as well as by THTR-2 . The main mechanisms of metformin involved in decreasing the endogenous glucose production and plasma glucose have all been extensively and critically reviewed elsewhere . In this review, the effects of metformin on the lipid metabolism are highlighted, thereby creating a special focus on the effects on lipids related to the activation of AMPK by metformin. Figure shows the specific interactions of metformin resulting in an improved lipid metabolism.

Fig. 4

Summary of the effects of metformin in the liver that cause an overall improved lipid metabolism by reducing triglycerides, LDL-C, and total cholesterol

In vivo experiments investigating the effects of statin treatment on glucose metabolism in T2DM patients showed no remarkable effects on EGP. Basal EGP in T2DM patients treated with atorvastatin or simvastatin showed no changes. However, the EGP measured during clamp conditions after 12 weeks of statin treatment was slightly increased compared with the baseline value in , but not in .

Summarizing, an increase of EGP induced by statins is not obvious from the above-mentioned studies performed in statin-treated T2DM patients, while it is observed in in vitro experiments. Therefore, it may be that the effects of statins on EGP are minor.

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What Do Statins Do For People With Diabetes

Statins affect the way the liver manufactures cholesterol, lowering levels of LDL cholesterol and raising levels of HDL cholesterol .

The terms good and bad cholesterol are used because, whilst we do need both types of cholesterol, having too high levels LDl cholesterol is linked with higher risks of heart disease whereas having high level of HDL cholesterol is linked with reduced risks of heart disease.

To Avoid Diabetes More Urgent To Focus On Addressing Weight And Lifestyle

That people are mildly more likely to become diabetic is something to consider, he says other study results had suggested the increased risk of developing type 2 diabetes is about 9%, he says, and is almost completely seen in individuals with a higher waist circumference, diagnosis of obesity, and higher blood triglyceride levels.

Statins seem to take anyone who almost has diabetes and push them over the edge, says Dr. Knowles. More to the point, the data suggest that the risks of T2D are similar whether you take a statin or not.

If you dont have prediabetes, are not overweight, and dont high triglycerides, your risk is closer to 3% over the next 7 to 8 years., and your risk is nearly the same at 2% if you dont take a statin. However, if you have prediabetes and are overweight, your risk without a statin is 15 to 18% and about 22% with a statin, he says.

The real significance of this latest study and other reports is that lifestyle changes, such as reducing excess weight and increasing physical activity can help avoid developing diabetes and reducing the risks associated with cardiovascular disease, Dr. Knowles says. The risks of not taking statins massively outweigh any risk that may come from taking them.

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Why Is High Cholesterol Dangerous

Atherosclerosis, fatty buildup in the arteries, can cause heart disease and damage to tissues in other parts of the body. It can be caused by too much cholesterol in the blood, and it is more common as we age. High cholesterol and atherosclerosis can lead to many health problems, such as heart attack, stroke, and kidney disease. So its important for everyone to keep their cholesterol levels low.

What Are Alternatve Options To Using Statin Ldl Lowering Medications

• If side effects are a concern for you, discussing alternate LDL lowering options.
• There are non statin cholesterol lowering medications available such as fibrates, Bile acid sequestrants, ezetimbe, PCSK9 inhibitors and discussing these medications and their potential side effect profiles with your prescriber can help you find the right medication options for you.
• Niacin has also been shown to reduce LDL, and triglycerides, however they have not been shown to reduce cardiovascular injury or deaths. This may be an appropriate option for persons whos LDL levels are less elevated or who have lower over all cardiovascular risk beyond lipid levels.
• It is possible that statin use may not need to be forever. Some persons may be able to use statins to more quickly lower LDL cholesterol while building lifestyle adjustments and alternate medication regimens to reduce to eliminate stain use eventually.

As always, it is important that we, as people with T1D, are educated and empowered to have these discussions with our prescribers. Ask what medication and therapy options are available, establish your goals and plans based on your personal/ family history, health needs, and priorities.

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Statins And Incident Diabetes Risk

Statin therapy is associated with an increase in the risk of hyperglycemia and diabetes. In one meta-analysis, statins were associated with a 9% increased risk of developing diabetes. To cause a new case of diabetes, 255 patients would have to be treated for a mean of 4 years. Compared to low-dose therapy, intensive therapy is associated with a 12% increase in risk of diabetes with a number needed to harm of 498 per year. People > 65 years of age are more susceptible to this unwanted effect. In a post hoc analysis of the Women’s Health Initiative study, statin treatment among postmenopausal women was associated with increased risk of diabetes . A 2013 meta-analysis showed that various types and doses of statins show different potential to increase the incidence of diabetes more potent statin therapy increases the risk of statin-induced hyperglycemia.

Statin therapy may accelerate the eventual expected rise of glucose values in people with multiple components of the metabolic syndrome. In the JUPITER study, 77% of participants had impaired fasting glucose, and a significant number of participants had metabolic syndrome and prediabetes at baseline in the rosuvastatin arm. In a review of three atorvastatin trials, four risk factors independently predicted new-onset diabetes: fasting glucose > 100 mg/dl, triglycerides > 150 mg/dl, BMI > 30 kg/m2, and history of hypertension).

Secondary Prevention: How Low Should We Go

In patients with overt CVD, the guidelines state an optional goal LDL of 70 mg%. This recommendation is based on several recently published trials that examined the effect of aggressive LDL lowering therapy in high risk populations of patients . In the PROVE-IT TIMI 22 trial, 4,162 patients 10 days after an acute coronary syndrome were randomized to standard 40 mg pravastatin treatment or high dose/aggressive 80 mg atorvastatin treatment . Patients were followed for 18 to 36 months and achieved an average LDL cholesterol level of 62 mg% in the atorvastatin group and 95 mg% in the pravastatin group. In the aggressive therapy group versus the control group, a significant 16% reduction in the primary end point was noted. 18% of the 1,600 patients in each treatment arm suffered from diabetes and showed similar risk reduction to that of the general cohort. A post hoc analysis of the PROVE-IT TIMI 22 trial data revealed a reduction not only in LDL cholesterol but also in CRP levels. This reduction in CRP was significantly associated with a reduction in cardiovascular events irrespective of the associated LDL reduction .

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Statin Use In Adults Aged 40 To 75 Years

Nineteen RCTs evaluated the effects of statins vs. placebo or no statins in adults aged 40 to 75 years without known CVD. Most of the trials, including the recently published HOPE-3 trial,8 enrolled participants based on an elevated LDL-C level, a diabetes diagnosis, or at least 1 CVD risk factor. Use of low- or moderate-dose statins was associated with a reduced risk of all-cause mortality , cardiovascular mortality , ischemic stroke , heart attack , and a composite cardiovascular outcome .6

Among the study populations, the proportion of CVD events prevented was similar across age, sex, race/ethnicity, lipid level, and other risk factor categories.6 Among trials that stratified participants according to a baseline global cardiovascular risk score, similar relative risk estimates were observed among those classified at a higher vs. lower CVD event risk.10,23

In the absence of other risk factors, adults with an LDL-C level greater than 190 mg/dL may still fall below the risk threshold for statin use for CVD prevention. As noted previously, these persons were generally excluded from the prevention trials evaluating the effects of statin use on health outcomes, because expert opinion strongly favors intervention for these individuals. It is possible that the relative risk reduction in this group is higher than in adults with a lower LDL-C level and that the absolute benefit is greater than would be predicted from a risk calculator.24

What Are The Side Effects Of Statin Medication

• Muscle pain/weakness/ damage: This is the most commonly reported effect of Statin use present in about 5% of use. These feelings of soreness, fatigue, heaviness or tightness of muscles can be reduced by slowly titrating medications, and by trying a different statin medication if you experience side effects from one. There is an extremely rare side effect called rhabdomyolysis that can cause severe muscle pain that can lead to permanent muscle damage, liver or kidney damage. This side effect presents in fewer than 3 in 1million cases.
• Liver damage: As with any medication that works on the liver, statin medications can cause an increase in liver enzymes by causing inflammation. Patients using stains should have a liver enzyme test before starting and follow up after starting the medication. Some statins are indicated to have ongoing liver function screenings done throughout use, while others have been able to get approval without the follow up lab indication.
• Neurological Impact: Some studies have shown a link to statin use and loss of memory of confusion. Though these appear to reverse when statins are discontinued the mechanism that causes the issue is not clear so discussing this risk with your prescriber is important. There is ongoing research as to whether there is a connection between long term statin use and neurological changes related to dementia and Alzheimers. However, there is also some evidence that statin use can improve brain function ins people with dementia

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Depleting Coq10 Linked To Parkinsons Diabetes Heart Issues

Other identified consequences of taking statins include your bodys ubiquinol levels, which is better known as CoQ10. This coenzyme is a critical part of any human or animals wellbeing, and statins have proven to drop CoQ10 levels in the body by as much as 50 percent, explained Reeves.

Present in every cell of your body, CoQ10 is necessary for the maintenance and production of energy. Its found in concentrated amounts in the tissue of your heart, brain, kidneys, and muscles. Its also a powerful antioxidant and fights-off free radicals that would otherwise damage your cells and DNA.

Significant disabilities might occur quickly in some, or it can take years in others when CoQ10 levels drop this severely, said Reeves.

Low levels of CoQ10 have been linked to diabetes, Parkinson, and other heart problems. In patients who began taking statins prior to developing any of those conditions, experts skeptical of statins postulate that the drug may have contributed to its onset.

A 2015 study from Japan suggests that not only do statins have little or no impact on preventing atherosclerosis, but this drug may also actually cause the buildup and hardening of fats, cholesterol, and plaque in your arteries increasing your risk of a heart attack or stroke.

The epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs, explained the study.

Antidiabetic Drug Metformin And The Potential Mechanisms By Which It May Affect Lipid Metabolism

Metformin, discovered in 1922, came on the market as late as 1979 . It belongs to the biguanide class of drugs, and is a derivative from guanidine found in Galega officinalis. Metformin is available in different formulations including immediate-release metformin, extended-release metformin , and delayed-release metformin . The latter two forms were developed to expand the absorption of metformin along the gut . Administration of metformin 30 min before a meal showed highest therapeutic efficacy in lowering postprandial hyperglycemia .

Table 2 Different formulations and the corresponding relevant characteristics of the oral drug metformin

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What Else Should I Know About Zocor

What preparations of Zocor are available?

• Tablets: 5, 10, 20, 40, and 80 mg.
• Orally disintegrating tablets: 10, 20, 40, and 80 mg.

How should I keep Zocor stored?

• Tablets should be stored between 5-30 C .
• Orally disintegrating tablets should be stored between 20-25 C .

How does simvastatin work?

Statins reduce cholesterol by inhibiting an enzyme in the liver that is necessary for the production of cholesterol. In the blood, statins lower total and low density lipoprotein or “bad” cholesterol as well as triglycerides. LDL cholesterol is believed to be an important cause of coronary artery disease. Lowering LDL cholesterol levels slows and may even reverse coronary artery disease. Statins also increase high density lipoprotein or “good”cholesterol. Raising HDL cholesterol levels, like lowering LDL cholesterol may slow coronary artery disease.

When was simvastatin approved by the FDA?

The FDA approved simvastatin in Decembe, 1991.

Primary Prevention Trials In Diabetes

Current clinical practice is based on relatively few randomized, control trials. Among these studies are the Heart Protection Study , the Collaborative Atorvastatin Diabetes Study , the Anglo-Scandinavian Cardiac Outcomes Lipid Lowering Arm , the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack study, and the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese trials. All of these studies included a substantial portion of subjects with diabetes. A few key primary prevention trials are summarized in .

The HPS provided initial evidence for the routine use of statin therapy in diabetes patients at risk for major CVD events. Patients with nonfasting total cholesterol > 135 mg/dl were randomized to 40 mg simvastatin daily versus a matching placebo. Statin-treated diabetes patients had a 22% relative risk reduction . Similar reductions were seen in those without baseline occlusive arterial disease and those with baseline LDL cholesterol levels < 116 mg/dl.

The ASCOT-LLA addressed lipid lowering in hypertensive patients in a 2 × 2 factorial analysis with atorvastatin, 10 mg, versus placebo. A baseline diagnosis of diabetes was present in 2,532 participants. Over a median follow-up of 3.3 years, there were 116 major CVD events in atorvastatin-allocated diabetes patients and 151 events in the placebo group .

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Coding And Documentation Guidance

Statin use is determined through medication claims data, and no physician coding is required.

However,it is important to document discussions with patients regarding the need for statins.

In addition, documentation regarding compliance or non- compliance with prescribed treatment should be done at the time of the office visit and also when medication reconciliation is performed.

Use G9664 for patients who are currently statin therapy users or received an order for statin therapy.

1Kidney damage is defined as abnormalities on pathological, urine, blood or imaging tests.

22013 ACC/AHA Prevention Guideline on the Treatment of Blood Cho- lesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, A Re- port of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 129:S1-S45

3Cholesterol Treatment Trialists Collaboration, Kearney PM, Blackwell L, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a metaanalysis. Lancet 2008 371:11725

4Pharmacy Quality Alliance . Statin use in persons with diabetes. Springfield : Pharmacy Quality Alliance 2015

* Evidence from 1 RCT only down-titration if unable to tolerate atorvastatin 80mg in IDEAL .

** Although simvastatin 80mg was evaluated in RCTs, initiation of sim- vastatin 80mg or titration to 80mg is not recommended by the FDA due to the increased risk of myopathy, including rhabdomyolysis.