UCL press release
Under embargo until 00:01 London time on Wednesday 24 September 2014 / 19:01 US Eastern
time on Tuesday 23 September
Modest effect of statins on diabetes risk and bodyweight related to mechanism of action
The mechanism by which statins increase the risk of type 2 diabetes has been investigated in a
large-scale analysis from an international team led by researchers from UCL and the University of
Glasgow, using information from genetic studies and clinical trials. Published in The Lancet, the work
received support from a number of funders including the Medical Research Council, British Heart
Foundation, Rosetrees Trust and National Institute for Health Research University College London
Hospitals Biomedical Research Centre.
Among nearly 130 000 participants from clinical trials that previously tested the effect of statins on
heart disease and stroke (major vascular events), those assigned statins vs. placebo, or higher vs.
lower doses of statins, were noted to have a small increase in risk of developing type 2 diabetes of
about 12% over a four-year period, and also to gain an excess of 240g (around half a pound) in
weight.
“Weight gain is a risk factor for diabetes which might help explain the small increased risk of diabetes
observed in people taking statins”, explains co-lead author Dr David Preiss of the University of
Glasgow Institute of Cardiovascular and Medical Sciences.
Statins work by reducing the efficiency of a liver enzyme involved in cholesterol production, which
causes liver cells to trap more low-density lipoprotein (LDL-) cholesterol from the bloodstream,
reducing its circulating level. This mechanism is thought to underlie the efficacy of statins in lowering
the risk of major vascular events.
“Commonly occurring variants in the gene encoding the same liver enzyme are associated with a
lower LDL-cholesterol,” explains co-lead author Dr Daniel Swerdlow of the UCL Institute of
Cardiovascular Science. “Incorporating information from up to 220 000 individuals, we found that
these genetic variants were also associated with a higher weight and marginally higher type 2
diabetes risk. The effects were very much smaller than from statin treatment, but the genetic findings
indicate that the weight gain and diabetes risk observed in the analysis from trials are related to the
known mechanism of action of statins rather than some other unintended effect.”
“The genetic findings of our study help to explain the mechanism by which statins increase weight
and diabetes risk,” says co-senior author Professor Aroon Hingorani, director of the UCL Institute of
Cardiovascular Science. “However, the effects of the genetic variants are orders of magnitude lower
than the effects of statins. There is also no indication from this study that an individual’s genetic
make-up will meaningfully affect their clinical response to statin treatment. Statin drugs should
continue to be prescribed without the need for any form of genetic testing.”
Taking the known risk of new onset diabetes into account, current guidelines from the UK National
Institute for Health and Care Excellence (NICE) suggest that statin treatment should be offered to
people with a 10% or higher risk of developing cardiovascular disease in the next 10 years. Statins
are also recommended for people who have had a heart attack or stroke to reduce the risk of future
incidents. Statins are effective in reducing cardiovascular events in people with established diabetes.
“Previous analyses have indicated that the cardiovascular benefits of statin treatment greatly
outweigh the risk of new-onset type 2 diabetes,” says co-senior author Professor Naveed Sattar of
the University of Glasgow Institute of Cardiovascular and Medical Sciences. “Nevertheless, many
patients eligible for statin treatment would also benefit from lifestyle changes including increased
physical activity, eating more healthily and stopping smoking. The modest increases in weight and
diabetes risk seen in this study could easily be mitigated by adopting healthier diets and lifestyles.
Reinforcing the importance of lifestyle changes when discussing these issues with patients would
further enhance the benefit of statin treatment in preventing heart attacks and strokes.”
-EndsNotes to Editors
For a copy of the paper, or to speak to Dr Swerdlow or Professor Hingorani, contact Harry Dayantis
in the UCL press office, T: +44(0)20 3108 3844, M: +44(0)7747 565056, E: h.dayantis@ucl.ac.uk
To speak to Dr Preiss or Professor Sattar, contact Stuart Forsyth in the University of Glasgow press
office, T: +44(0)141 330 4831, M: +44(0)7854 034 342, E: Stuart.Forsyth@glasgow.ac.uk
Swerdlow et al., HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence
from genetic analysis and randomised trials, will be published in The Lancet at the following
URL:http://dx.doi.org/10.1016/S0140-6736(14)61183-1
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About the University of Glasgow
Founded in 1451, the University of Glasgow is the fourth oldest university in the English-speaking
world. Today it is a broad-based, research intensive institution with a global reach with more than
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satisfaction among universities participating in the International Student Barometer Summer 2013,
the University of Glasgow ensures its students graduate equipped with the skills they need to
compete in a global workplace.
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