Don't use DIABETES as a CV risk equivalent

Learn the best practices for managing cholesterol and reducing heart disease risk in diabetic patients.
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

As a pharmacy doctor, you will see more consensus on using statins for diabetes patients. We all know the controversy about the ACC/AHA cholesterol guidelines that abandoned LDL goals and recommended specific statin doses instead. Now the American Diabetes Association is following suit and providing similar guidance on when to use a statin in diabetes patients.

Make sure that most type 1 or 2 patients between ages 40 and 75 are prescribed a statin. Keep in mind, diabetes is NOT always a cardiovascular risk (CV) equivalent. CV risk in diabetes patients varies based on age and other CV risk factors (i.e., smoking, hypertension, dyslipidemia, family history of premature heart disease, albuminuria) and so should statin doses.

Table (1). Recommendations of Statins
Medication Indication
High-intensity: atorvastatin (Lipitor, 40 to 80 mg per day) or rosuvastatin (Crestor, 20 to 40 mg per day) Patients younger than 75 years
Moderate-intensity: atorvastatin (10 to 20 mg per day), rosuvastatin (5 to 10 mg per day), simvastatin (Zocor, 20 to 40 mg per day) Patients 75 years and older, or in whom high-intensity statins are not tolerated

NPS-adv

In general, use a MODERATE-intensity statin (atorvastatin 20 mg, etc) for diabetes patients withOUT other CV risks and a HIGH-intensity statin (atorvastatin 80 mg, etc) for those with CV disease or risk factors "see table 1". To fine-tune statin intensity, consider using the ACC/AHA cardiovascular risk estimator. Use a HIGH-intensity statin if the 10-year CV risk is = 7.5%. Most diabetes patients over age 50 will fall into this category.

References

  1. American Diabetes Association. (8) Cardiovascular disease and risk management. Diabetes Care. 2015 Jan;38 Suppl:S49-57.
  2. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889-2934.