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Nearly All With Type 2 Diabetes Need Statins

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April 19, 2004 -- There are new guidelines on statin use. Experts now say no matter how low the cholesterol count, nearly all people with diabetes should take these cholesterol-lowering drugs.

That advice now is part of the official practice guidelines of the American College of Physicians, a major doctors' group. The guidelines -- and a review of all clinical trials of statins in patients with diabetes -- appear in the April 20, 2004 issue of the ACP's Annals of Internal Medicine. Vincenza Snow, MD, the ACP's senior medical associate for science policy, is lead author of the new recommendations.

"As we were doing the review, we were very interested to see that for preventing first-time and recurring heart disease in type 2 diabetes, there is a very significant benefit to statins," Snow tells WebMD. "And this benefit does not end at normal or even low cholesterol levels. That the statins seem to have some other protective property beyond cholesterol lowering."

Statins Advised for Nearly All With Type 2 Diabetes

The old guidelines recommend statins for patients with type 2 diabetes if their bad LDL cholesterol level is over 100 and if they have at least one risk factor for heart disease. Available statins include Crestor, Lescol, Lipitor, Pravachol, and Zocor.

The new guidelines say anyone with type 2 diabetes and one heart disease risk factor should be taking one of the drugs. These risk factors are:

  • More than 55 years of age
  • High blood pressure
  • High LDL "bad" cholesterol (over 100)
  • Smoking
  • Physical inactivity
  • Obesity
  • Existing heart disease

This includes all but a few younger patients with type 2 diabetes, says Sandeep Vijan, MD, researcher of the review of statin/diabetes studies. Vijan is an investigator at the Ann Arbor VA Health Services and Research Center and assistant professor of internal medicine at the University of Michigan, Ann Arbor.

"If you look at the numbers, between 50% and 75% of people with type 2 diabetes have high blood pressure, and most are over 55," Vijan tells WebMD. "And maybe 20% smoke and 45% to 60% have coronary artery disease. So by the time you add all those things up, you are talking about almost everybody with type 2 diabetes."

Once people with diabetes start taking statin drugs, the new guidelines say, they should keep taking it -- no matter how low their cholesterol goes.

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