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 20 February 2018

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News

Statins in patients with type 2 diabetes

People with type 2 diabetes mellitus and coronary artery disease or any other risk for cardiovascular disease should be taking statins, state new guidelines from the American College of Physicians.

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New guidelines state that people with type 2 diabetes mellitus and coronary artery disease, or diabetes and any other risk for cardiovascular disease should be taking statins.

New guidelines from the American College of Physicians (ACP) are published in the latest issue of the Annals of Internal Medicine.

This is the second ACP guideline on aggressive management of risk factors for cardiovascular disease in people with type 2 diabetes.

In April 2003, ACP called for tight control of blood pressure for people with diabetes.

An estimated 80% of people with type 2 diabetes will develop or die of complications of heart and vessel disease. About 65% of deaths among people with diabetes are due to heart disease and stroke, according to the American Diabetes Association.

"We want both physicians and patients to know that when treating diabetes, controlling cardiovascular risk factors, particularly cholesterol levels and high blood pressure, is as important as controlling blood sugar," said Dr Vincenza Snow of the American College of Physicians.

"In addition to controlling blood sugar levels, people with diabetes may be surprised to know that they must also be vigilant about controlling their blood pressure and cholesterol levels."

An estimated 18.2 million Americans have type 2 diabetes.
Annals of Internal Medicine

The numbers of people with type 2 diabetes is growing rapidly in the United States.

An estimated 18.2 million Americans, or about 6% of the population, have type 2 diabetes, and an additional 1.3 million people aged 20 or older are diagnosed with the disease each year, according to the American Diabetes Association.

The new ACP guidelines are targeted at both patients and primary care physicians.

For patients, ACP is issuing a video news release to alert people with type 2 diabetes and their families about the importance of controlling cholesterol.

For ACP physician members, evidence-based guidelines on all aspects of diabetes treatment are important.

ACP lists these guidelines to control cholesterol in people with diabetes:

  1. All adults with type 2 diabetes and known CAD should be taking statins, regardless of their cholesterol levels.
  2. All adults with type 2 diabetes and another risk factor for coronary artery disease, such as high blood pressure, high cholesterol, smoking, physical inactivity or obesity, should be taking statins or the non-statin drug gemfibrozil, regardless of cholesterol levels. This group includes premenopausal women with diabetes and another risk factor.
  3. Once started on cholesterol-lowering therapy, patients with type 2 diabetes should remain on at least moderate doses of a statin. Physicians should not delay starting statin treatment until cholesterol reaches a certain level and should not "treat to a target" level of cholesterol.
  4. Routine monitoring of liver function or muscle enzymes is probably not needed for those patients with type 2 diabetes who are taking statins, except if they also have a liver abnormality or muscle pain or are taking drugs that interact with statins.

The ACP guidelines call special attention to premenopausal women with diabetes.

"Women with diabetes who have not reached menopause may think their female hormones protect them from CAD," said Dr Snow.

"But statistics show that premenopausal women with type 2 diabetes and at least one other cardiovascular risk factor are as likely as men to develop CAD.

"So ACP says that women with diabetes and other risk factors for CAD should take a statin."

Diabetes is itself a major risk factor for heart disease. Other risk factors are high blood pressure, high blood cholesterol, physical inactivity, obesity and overweight, smoking, and older age.

The guidelines are based on a systematic review of evidence about cholesterol-lowering drug therapy in people with diabetes who have coronary disease already or who have risk factors for coronary disease.

In these studies, the authors looked at the benefits of tight lipid control in primary prevention and in secondary prevention.

The ACP authors concluded that statins are extremely safe, except for patients who have liver problems or are taking drugs that interact with statins.

Ann Intern Med 2004; 140(8):
20 April 2004

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