Role of Statins in Glucose Homeostasis and Insulin Resistance

Statins are widely used for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD), and, under the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol treatment guidelines, more individuals are eligible for statin therapy. In this review, we summarize evidence for a mild increase in serum glucose and increased incidence of diabetes associated with statins, the hypothesized mechanisms by which statins may impair glucose homeostasis, the risk of diabetes associated with particular statins, and the net effect on ASCVD risk. As emphasized by the ACC/AHA guideline group and other experts, the risk-reducing benefits of statin therapy generally outweigh the mild rise in glucose levels or new diagnoses of diabetes. As such, an appropriate balancing of benefits and risks is critical in clinical practice as clinicians engage patients in shared decision making. Moreover, when discussing statins and risk of diabetes, this is a prime opportunity for clinicians to provide further counseling on the central importance of weight loss and adhering to a healthy lifestyle in glucose homeostasis and diabetes prevention.