House Calls - Diabetes

Q. I've read that, because I have type 2 diabetes, I should take a statin even though my cholesterol levels are normal. Is this true?

A. 'Perhaps. Type 2 diabetes is considered a risk factor for heart disease and addressing this risk is a primary goal in treatment. Recent research has shown that people with type 2 diabetes but no known history of coronary heart disease (CHD) have a heart attack risk similar to that of nondiabetics with CHD. Thus when choosing treatment, doctors often assume people with type 2 diabetes have had a coronary event, whether they have or not.

Therapy with cholesterol lowering statin drugs has been considered for people with type 2 diabetes because their effectiveness in reducing a person's risk for heart attack or stroke is so well documented. And recent research suggests that statins offer heart protection beyond controlling cholesterol levels.

The American College of Physicians (ACP) recommends that people with type 2 diabetes should take moderate doses of a statin if they have CHD or at least one risk factor for CHD, even if their cholesterol levels are normal.

The ACP based their recommendation on the pooled results of 12 trials documenting the benefits of this cholesterol lowering therapy in patients with diabetes, with or without CHD. Overall, statin therapy reduced the risk of a cardiovascular event by 22 per cent.

Additional risk factors for CHD, besides diabetes and LDL cholesterol levels over 100 mg/dL, include hyper-tension, smoking, physical inactivity, obesity, and older age (over 55 years).

Recommended starting dosages of various statins are:

• atorvastatin (Lipitor): 10 mg;
• lovastatin (Mevacor): 40 mg;
• pravastatin (Pravachol): 40 mg;
• simvastatin (Zocor): 20 to 40 mg;
• fluvastatin (Lescol): 40 to 80 mg; and
• rosuvastatin (Crestor): 5 to 10 mg.

Source : Johns Hopkins Medical Letter

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