It is estimated that over 17 million people die of cardiovascular disease (CVD) annually, with one American dying of CVD every 33 seconds on average. In addition to maintaining a healthy diet and active lifestyle, drugs known as “statins” are commonly used to treat heart disease.
Statins are hydrophilic (water-soluble), synthetic compounds which work by inhibiting the production of cholesterol, as well as aiding in the reabsorption of cholesterol built up in plaques on artery walls. This improves transport of blood through the arteries, thus reducing strain on the heart. By doing this, the chances of patients with CVD of having cardiac arrest or a stroke decreases. The hydrophilic nature of statins enables them to reach their target regions efficiently, without damaging internal organs or disrupting the central nervous system.
However, according to the U.S. Food and Drug Administration (FDA), statins such as Lipitor have been shown to increase an individual’s blood sugar levels and promote the development of Type 2 Diabetes (T2D). As a result, the FDA has implemented a regulation which requires all statin labels to include a warning about elevated blood sugar levels and T2D. This revelation has influenced many individuals to refuse to take statins, due to the risk of developing T2D and high blood glucose levels. These complications would create insulin resistance in the patient, consequently harming their cardiovascular health and making them prone to other cardiovascular diseases such as atherosclerosis.
However, by refusing to take statins, patients will endanger themselves by worsening their cardiovascular health. This conflict has left many consumers unsure of what end of the balance to lean on – whether it’s ceasing to take statins or continue to take them with the risk that they pose.
Thankfully, researchers at McMaster University’s Department of Biochemistry and Biomedical Sciences have developed a potential solution. Assistant professor and Canadian Diabetes Association Scholar, Dr. Schertzer, has discovered a pathway that connects statins and diabetes. He and his team “found that statins activated a very specific immune response, which stopped insulin from doing its job properly.” Through persistent research, they discovered that a drug called Glyburide mediated the effect of elevated blood sugar levels. According to Schertzer, this discovery has the potential for development of novel molecules which do not interfere with the benefits of statins in the immune pathway.
At this stage of the process, the group aims to determine how statins promote diabetes by understanding how they behave in the pancreas, which is responsible for the secretion of insulin. Dr. Schertzer and his team advocate the therapeutic properties of statins, as they are drugs which elicit positive results. However, in order to improve them they must understand the “immune-metabolism pathway” which statins have been theorized to act on.
By introducing statins that do not pose such a risk of insulin resistance, consumers will be able to comfortably take their heart medications, knowing that they are taking their health in the right direction.
By: Bernard Ho
In patients experiencing diabetes mellitus, the body is either unable to produce insulin or is resistant to the body’s own insulin. The usual treatment for this ailment is exercise and dietary modifications, but when the disease becomes more severe, exogenous insulin injections must be given on a consistent basis in order to regulate blood sugar levels. However, past observational studies have shown that higher insulin levels are associated with an increased risk of cardiovascular disease. Thus, insulin injections to treat diabetes may lead to problems elsewhere in the body.
Recently, researchers at McMaster University put this belief to the test. Dr. Hertzel Gerstein, a professor at McMaster’s DeGroote School of Medicine and deputy director of the Population Health Research Institute, conducted a randomized control trial along with several other researchers to determine whether exogenous insulin increases the risk of cardiovascular disease. In the study, over 12,500 people from 40 countries, who were at high risk for or were in the early stages of Type II diabetes, were randomized to either one daily injection of insulin or no insulin for an average of six years. After analyzing the data, researchers found no difference amongst the two groups in cardiovascular outcomes.
“People have been debating the question of whether there are adverse consequences to long-term insulin use for years,” said Gerstein. “This study provides the clearest answer yet to that question: no, there are not.” Indeed, the hazard ratio for heart disease between the treatment groups was 1.02, meaning that those who were given insulin experienced cardiovascular outcomes at almost the same rate as those who were not. Moreover, the participants of the study given insulin maintained normal fasting blood sugar levels, below 6 mmol/L.
A second key finding discovered by the researchers was that those who do not yet have diabetes, but are at a high risk of developing the illness and who receive daily insulin injections, have a 28% lower chance of developing the disease, even after the injections are stopped. This suggests that some people who start insulin injections won’t necessarily be looking at treatment for the rest of their lives. The study also confirmed the presence of two previously known side effects of exogenous insulin – hypoglycemia (low blood sugar) and modest weight gain. Both were considered to be minor from a medical perspective, with participants experiencing a small risk of hypoglycemia and gaining an average of 3.5 pounds during the study.
This study was part of a larger study known as the ORIGIN (Outcome Reduction with Initial Glargine Intervention) Trial, led by Dr. Gerstein and Dr. Salim Yusuf, that also looked at the effects of omega-3 fatty acids on cardiovascular diseases. The ORIGIN Trial has since been completed and the results have been published in the New England Journal of Medicine.