Cholesterol Pills and Diabetes

Sep 9, 2014

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

September 11th. The date is almost a punch line itself. Where were you on September 11th? I know where I was September 11th, 1999. I was at Rowendale Baptist Church, just off Pembina Hwy in North Kildonan. I was there with a very pretty girl who got baptized in that Church. She was so nervous that her bouquet was vibrating. Her grandmother said we should have moved up the wedding a few days so our anniversary date would have been 9-9-99. Apparently that was trendy in Germany at the time. 9-1-1 was our own private joke for a couple of years. Then a horrible event forever tainted the date. I think its time to take the date back.

Lately, several people have wanted to take their cholesterol medications back to the pharmacy. A very common class of cholesterol medication called statins have been reported to increase the chance of a person getting diabetes. Is this true and does it matter? This goes back to a study in 2008 called JUPITER. It looked a cholesterol pill called rosuvastatin or crestor to see if it could prevent heart attacks, strokes and a bunch of other heart problems in people with normal LDL cholesterol levels and high C-reative protein levels. The answer was yes, but it was only a small benefit. An interesting afterthought was that JUPITER showed that about 6 extra people out of 1000 would become diabetic after 2 years on rosuvastatin. This is where the controversy started.

What is cholesterol? Cholesterol is a naturally occurring substance in the body that is essential for life. If you had no cholesterol in you, you would die. Cholesterol helps form bile acids in your digestive system, hormones in your endocrine system and important components of every cell membrane in your body. Although cholesterol is essential for life, you dont have to eat any. Your liver can make all the cholesterol you need.

Why does your doctor test your blood for cholesterol if it is essential for life? Why does your doctor care if your cholesterol is too high? Your doctor cares about blood cholesterol levels because if they are too high for too long you have higher chance of getting a heart attack or a stroke. Heart attacks and strokes account for about one third of all the deaths in Canada.

The primary target of cholesterol lowering therapy is something called LDL. If LDL or bad cholesterol is high, we have many, many studies saying that increases the patients chance of having a heart attack or stroke. The most common LDL lowering medications are the statins. The statins stop the liver from making as much cholesterol. The statins do a good job of reducing LDL. In fact, if we reduce someones LDL with statins we can reduce their chances of heart attacks and strokes by 25% to 35% with five years use.

What does all this LDL, and HDL stuff mean? When your liver makes cholesterol, it puts it into the blood stream. Cholesterol is a kind of fat or lipid. Since blood is mostly water, cholesterol doesnt mix well with it. The liver has to mix the cholesterol with proteins to get it to stay in the blood. This mixture of cholesterol and protein is called a lipoprotein. If you take a blood sample and spin it really fast in a centrifuge, it separates based on density. Different layers in the sample have different densities. Low Density Lipoprotein or LDL is often called bad cholesterol because it transports cholesterol from the liver to places like the lining inside the arteries. Through a complicated series of events, these cholesterol deposits can cause blockages that slow or stop blood flow. If blood flow to the heart muscle is stopped, that is a heart attack. If blood flow to the brain is stopped that is a stroke. High Density Lipoprotein or HDL is called good cholesterol because it transports cholesterol away from the cells lining the blood vessels. This can decrease the chance of blockages.

Back to statins causing diabetes. There have been other studies confirming that statins cause diabetes effect and some that dispute it. In 2012, the FDA in the US said labels on statin drugs must now warn they might make blood sugar go up. But this effect, even if it is real, probably doesnt matter. In the original JUPITER trial, by the fact the participants had high C-reactive protein levels and a few other conditions, made them at high risk of diabetes anyway. The placebo group in the JUPITER trial actually had lower blood sugars as measured by H1AC BEFORE the trial started. These are some of the reasons why we are still not sure if this blood sugar raising effect is real. But even if it is, the benefit of lowering LDL cholesterol outweighs the risk of becoming diabetic. In other words being on a statin will prevent more deaths in people with high cholesterol than if those people werent on statins even if a small number of them become diabetic.

Yes, there should be more study to see if this statin-diabetes effect is real. Yes, doctors should check the blood sugars of their statin treated cholesterol patients. But no, dont let a couple media reports scare you away from your cholesterol pill. You are better taking your statin than not. Take back your right to prevent heart attacks and strokes.

I want to take back September 11th too. No disrespect to victims of terror, but September 11th was a happy day for many of us. Ive met many people, young and old, with birthdays on September 11th. Lets celebrate them. I know I cant be the only one with a September 11th Wedding Anniversary. Lets reminisce about the last time I made a decision on my own. September 11th is a happy day for many of us. Lets remember that.

I am Trevor Shewfelt from the Dauphin Clinic Pharmacy. The Pharmacy Feature is heard here every Tuesday on 730 CKDM

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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