他汀类降胆固醇药会增加2型糖尿病的风险高达50%

Statins Linked to Raised Risk of Type 2 Diabetes

　

芬兰的一项大型研究发现，服用降胆固醇药物的人患糖尿病风险增加了近50%。

丹尼斯·汤普森，每日健康记者

周三，2015年3月4日(健康日新闻)——芬兰的一项新研究表明，降胆固醇他汀类药物可能会显著增加一个人患2型糖尿病的风险。

研究人员发现，即使在调整了其他因素后，他汀类药物也能使患2型糖尿病的风险增加近50%。

研究人员说，他汀类药物似乎在几个方面增加了患2型糖尿病的风险。据报道，一种是这些药物会增加人的胰岛素抵抗，另一种是降胆固醇药物似乎会削弱胰腺分泌胰岛素的能力。

罗纳德·戈德堡博士，他是迈阿密大学脂质紊乱诊所的主任和糖尿病研究所的副主任,这样评价这个研究，“显示的证据表明,他汀类药物增加胰岛素抵抗,而发展了糖尿病的人似乎已经减少对胰岛素抵抗的反应能力,因而生产更多的胰岛素。

然而，研究作者指出，他们的研究只发现了他汀类药物的使用与糖尿病风险之间的联系。由于这项研究仅限于白人男性，因此尚不清楚这项研究结果是否适用于女性或其他种族群体。

据美国糖尿病协会(ADA)统计，美国有超过2900万人患有糖尿病。当人体对胰岛素产生抗药性时，就会出现2型糖尿病。胰岛素是一种处理食物中糖分所需的激素。为了弥补，身体会产生更多的胰岛素。根据ADA的说法，超重和久坐的生活方式是2型糖尿病的两个重要危险因素。

作者在研究背景资料中说，先前的研究表明他汀类药物可能增加一个人患糖尿病的风险。然而，这些早期的研究主要关注他汀类药物在预防心脏病方面的作用，而不是它们潜在的糖尿病风险。

在这项新的研究中，东芬兰大学(University of Eastern Finland)的研究人员在6年的时间里追踪了近9000名没有患糖尿病的男性，追踪了他汀类药物治疗的效果。这些人年龄在45岁到73岁之间。在研究开始时，四分之一的男性服用他汀类药物。

这些人的健康状况被跟踪了将近六年。研究人员说，在此期间，有625名男性新诊断为2型糖尿病。即使考虑到其他风险因素，服用他汀类药物的人比未服用他汀类药物的人患糖尿病的可能性高出46%。

　

随着他汀类药物辛伐他汀(辛伐他汀)和阿托伐他汀(立普妥)剂量的增加，患糖尿病的风险增加 

研究人员说，随着他汀类药物辛伐他汀(辛伐他汀)和阿托伐他汀(立普妥)剂量的增加，患糖尿病的风险增加。

更深入的研究发现，他汀类药物降低了24%的胰岛素敏感性，胰岛素分泌降低了12%。人们服用的辛伐他汀和阿托伐他汀越多，他们使用和产生胰岛素的能力就越差。

大剂量辛伐他汀可使患糖尿病的风险增加44%，而小剂量辛伐他汀的风险增加28%。研究发现，大剂量阿托伐他汀与糖尿病风险增加37%有关。

　

大剂量辛伐他汀可使患糖尿病的风险增加44% “医生和病人必须权衡风险和益处，然后决定怎么做"。

 

范德比尔特大学医学中心(Vanderbilt University Medical Center)糖尿病、内分泌和代谢科主任鲍尔斯(Al Powers)说，基于这些发现，医生在开他汀类药物处方前必须权衡利弊。

鲍尔斯说，糖尿病前期患者需要特别考虑，因为他们已经处于发展为2型糖尿病的边缘。

鲍尔斯说:“在这种情况下，医生和病人必须权衡风险和益处，然后决定怎么做。”

他补充说，另一方面，他汀类药物的处方对已经被诊断出患有2型糖尿病的人来说并不重要，因为他们已经在接受治疗。鲍尔斯说:“这些患者应该继续接受他汀类药物治疗。”

Goldberg预计大多数需要他汀类药物的心脏病患者将继续接受治疗，但需要密切监测他们的血糖水平。

“如果你患心脏病的风险高,他汀类药物治疗的好处是如此重要,大多数医生和病人,向他们解释的时候,愿意承担增加糖尿病的风险，换取预防心脏病发作和中风的好处,”戈德堡说。

贝勒医学院(Baylor College of Medicine)教授艾伦·加伯(Alan Garber)博士说，血糖水平开始上升的他汀类药物使用者可能通过饮食和锻炼来预防2型糖尿病。加伯是《糖尿病、肥胖和代谢》杂志的编辑。

“解决办法是通过饮食和锻炼来改变生活方式。无论如何，对于高胆固醇你应该这样做。“对于生活中的所有危险因素，没有简单的万灵药。很明显，单片药并不能取代个人自我管理。病人必须学会照顾自己。

这项研究结果发表在3月4日出版的《糖尿病研究》杂志上。

　

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Statins Linked to Raised Risk of Type 2 Diabetes

Large Finnish study found a nearly 50 percent increase in people taking cholesterol-lowering drugs

FROM THE WEBMD ARCHIVES

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, March 4, 2015 (HealthDay News) -- Cholesterol-lowering statin drugs may significantly increase a person's risk of developing type 2 diabetes, a new study from Finland suggests.

Researchers found that statins were associated with an almost 50 percent higher risk of developing type 2 diabetes, even after adjusting for other factors.

Statins appear to increase the risk of type 2 diabetes in several ways, the researchers said. One is that the drugs can increase a person's insulin resistance, and the other is that the cholesterol-lowering drugs seem to impair the ability of the pancreas to secrete insulin, according to the report.

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Commenting on the study, Dr. Ronald Goldberg, director of the Lipid Disorder Clinic and associate director of the Diabetes Research Institute at the University of Miami, said the researchers "show evidence that statins increased insulin resistance, and that the people who developed diabetes appeared to have less ability to respond to the insulin resistance by making more insulin."

The study authors noted, however, that their research only found an association between statin use and diabetes risk. And since the study was limited to white men, it's not clear if the findings would apply to women or other racial groups.

More than 29 million people in the United States have diabetes, according to the American Diabetes Association (ADA). Type 2 diabetes occurs when the body becomes resistant to insulin, a hormone needed to process the sugars found in foods. To compensate, the body produces more insulin. Excess weight and a sedentary lifestyle are two important risk factors for type 2 diabetes, according to the ADA.

Prior studies have indicated that statins may increase a person's risk of diabetes, the authors said in background information in the study. However, these earlier studies were focused mainly on statins' role in preventing heart disease, not on their potential diabetes risk.

In this new study, University of Eastern Finland researchers tracked the effects of statin treatment in almost 9,000 men without diabetes over the course of six years. The men were between 45 and 73 years old. One in four of the men was taking a statin at the beginning of the study.

The health of the men was followed for nearly six years. During that time, 625 men were newly diagnosed with type 2 diabetes, the researchers said. Even after other risk factors were accounted for, people treated with statins were 46 percent more likely to develop diabetes than those not treated with statins.

The diabetes risk increased with the dosage taken of the statin drugs simvastatin (Zocor) and atorvastatin (Lipitor), the researchers said.

Digging a little deeper, the investigators found that statins decreased insulin sensitivity by 24 percent, and insulin secretion by 12 percent. The more simvastatin and atorvastatin that people took, the more their ability to use and produce insulin suffered.

High-dose simvastatin was associated with a 44 percent increased risk of developing diabetes, while for low-dose simvastatin the increased risk was 28 percent. High-dose atorvastatin was linked to a 37 percent increased diabetes risk, the study found.

Based on these findings, physicians will have to weigh risks versus benefits before prescribing statins, said Dr. Al Powers, director of the division of diabetes, endocrinology and metabolism at Vanderbilt University Medical Center.

Patients with pre-diabetes will need particular consideration, given that they are already on the verge of developing type 2 diabetes, Powers said.

"That's a situation where the physician and the patient must weigh the risks and benefits and decide what to do," Powers said.

On the other hand, statins can be prescribed without concern to people already diagnosed with type 2 diabetes, since they are already being treated for the condition, he added. "Those patients should continue their statin treatment," Powers said.

Goldberg expects that most heart patients who need statins will continue to receive them, but with close monitoring of their blood sugar levels.

"If your risk for heart disease is high, the benefit of statin therapy is so important that most physicians and most patients, when it's explained to them, will be willing to incur the increased risk of diabetes in favor of the added benefit to preventing heart attack and stroke," Goldberg said.

Dr. Alan Garber, a professor at Baylor College of Medicine, said that statin users with blood sugar levels beginning to creep up can likely head off type 2 diabetes through diet and exercise. Garber is the editor of the journal Diabetes, Obesity and Metabolism.

"The solution is lifestyle modification with diet and exercise. You should do that for high cholesterol, anyway," Garber said. "There's no simple cure-all for all the risk factors in life. It's clear that a single pill isn't going to supplant individual self-management. Patients have to learn to take care of themselves."

The findings were published March 4 in Diabetologia, the journal of the European Association for the Study of Diabetes.

https://www.webmd.com/diabetes/news/20150304/statins-linked-to-raised-risk-of-type-2-diabetes#1