Ensure your DIABETIC patients are on statin

Think of statins as "automatic" for most of these adults with diabetes, regardless of LDL. Generally start with a moderate-intensity statin....
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

Many eligible adults with diabetes aren’t on a statin. We know that statins reduce cardiovascular (CV) risk in patients with type 1 or 2 diabetes, and guidelines recommend use. Plus statin use in patients with diabetes age 40 to 75 is a common quality measure. Follow these steps...

Think of statins as "automatic" for most of these adults with diabetes, regardless of LDL. Generally, start with a moderate-intensity statin (atorvastatin 20 mg, etc), but step up to high-intensity (atorvastatin 80 mg, etc) for secondary prevention patients, such as post-MI or stroke. It’s also reasonable to bump up to a high-intensity statin in those with multiple CV risks (hypertension, kidney disease, etc), or a 10-year CV risk of 7.5% or more using the American College of Cardiology/American Heart Association risk estimator. Think about adding ezetimibe (Choletimb) 10 mg once daily if 10-year risk is 20% or greater. For primary prevention in adults with diabetes UNDER age 40 or OVER age 75, individualize statin decisions based on CV risk. Evidence isn’t as strong in these patients.

Then help set the stage for success by getting patient buy-in. Ask what they’ve heard about statins, listen to their concerns and fill in gaps to help them see the value. For instance, explain to patients that diabetes roughly doubles CV risk. But statins can protect the heart and brain by reducing heart attack and stroke risk, even if cholesterol isn’t high.

NPS-adv

Clarify how these CV benefits outweigh risks. For example, any bump in A1C after starting a statin is small, about 0.2% or less. Reassure that muscle pain or weakness can often be managed, if it occurs. Evaluate other possible causes or interactions, or discuss options to retry a statin at a lower dose or use a different statin. Educate that fewer than 1 in 10,000 statin patients have rhabdomyolysis. And statins don’t cause dementia or cancer. Be aware that pharmacists are also striving to impact a quality measure about statin use in patients with diabetes age 40 to 75. Watch for their recommendations, and work together to close gaps in therapy. Find more ways to help patients manage muscle symptoms and stick with their statin IN OUR NOTE, "How to handle statin muscle pain?".

References

  1. American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2021. Diabetes Care. 2021 Jan;44(Suppl 1):S125-S150.
  2. Shaw JA, Cooper ME. Contemporary Management of Heart Failure in Patients With Diabetes. Diabetes Care. 2020 Dec;43(12):2895-2903.
  3. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019 Jun 25;73(24):3168-3209.
  4. Gilstrap LG, Chernew ME, Nguyen CA, Alam S, Bai B, McWilliams JM, Landon BE, Landrum MB. Association Between Clinical Practice Group Adherence to Quality Measures and Adverse Outcomes Among Adult Patients With Diabetes. JAMA Netw Open. 2019 Aug 2;2(8):e199139.