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.
- More than 55 years of age
- High blood pressure
- High LDL "bad" cholesterol (over 100)
- Physical inactivity
- 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.
Safety Not Seen As Issue
The most infamous member of the statin class of drugs is the now discontinued Baycol, which had life-threatening side effects. But the other statins seem to be fairly safe -- except for people who have liver disease or for people who are taking other drugs that can combine with statins to cause liver damage.
"There is a little bit of a conflicting data on the safety -- different statins have different risks, although Baycol seems to be an outlier," Vijan says. "If you look at the clinical trials, the rate of liver abnormalities in people who took statins is not different than in the placebo group. And liver experts tell me they see none of these problems. So routine monitoring of liver function is not necessary unless symptoms develop. But you have to be careful to make sure that patients aren't taking certain other drugs that have adverse interactions with statins."
People taking statins should talk with their doctors before starting any new medicine or herbal supplement.