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    • 06 JUL 17

    Statin Therapy for Diabetes

    Statin Therapy for Diabetes

    What you need to know

     

    What Are LDLs and HDLs?

    These are both terms for a combination of fat and proteins that circulate in your blood. Your doctor can monitor these with a simple blood test. LDL (Low-Density Lipoprotein) represents your “bad” cholesterol. LDLs can form plaques inside your blood vessels leading to clogged arteries. When the arteries become clogged it can cause a heart attack or stroke. HDL (High-Density Lipoprotein) represents your “good” cholesterol. HDLs act as hunters for LDLs. The HDLs will carry your LDLs to the liver to be removed from your body. Increasing levels of HDLs is just as important as lowering LDLs in preventing heart attacks and strokes.

    What Are Statins?

    Statins are drugs that help to block the liver from making cholesterol. Blocking this will decrease your LDLs, but that’s not all. Statins have also been shown to improve the lining of your blood vessels, decrease inflammation in your blood vessels, and reduce the chance of clots forming in your blood. Statins are one of the most effective medications for preventing stroke and heart attack. Depending on your risk factors and past medical history your doctor will decide what intensity of statin you may need.

    High-intensity statin therapy
    lowers cholesterol by ≥50%
    Moderate-intensity statin therapy
    lowers cholesterol by 30 – 50%
    Low-intensity statin therapy
    lowers cholesterol by < 30%
    Atorvastatin (Lipitor®) 40 – 80 mg a day
    Rosuvastatin (Crestor®) 20 – 40 mg a day**
    Atorvastatin (Lipitor®) 10 – 20 mg a day
    Rosuvastatin (Crestor®) 5 – 10 mg a day**
    Simvastatin (Zocor®) 20 – 40 mg a day 
    Pravastatin (Pravachol®) 40 – 80 mg a day
    Lovastatin (Mevacor®) 40 mg a day
    Fluvastatin XL (Lescol XL®) 80 mg a day 
    Fluvastatin (Lescol®) 40 mg twice a day
    Pitavastatin (Livalo®) 2 – 4 mg a day**
    Simvastatin (Zocor®) 10 mg a day
    Pravastatin (Pravachol®) 10 – 20 mg a day
    Lovastatin (Mevacor®) 20 mg a day
    Fluvastatin (Lescol®) 20 – 40 mg a day
    Pitavastatin (Livalo®) 1 mg a day**

    * Statin use in patients > 75 years old may be warranted
    ** Only available as brand medication

    Stone N, Robinson J, Lichtenstein A 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. Circulation. 2013;129(25_suppl_2);S1-S45.

     

    Why Statin therapy for patients with Diabetes?

    People with diabetes have more than twice the risk of developing cardiovascular disease compared to people without diabetes. Even if your LDL and HDL levels are within normal range diabetics are more prone to blood vessel damage, which increases the risk of cardiovascular disease. These damaged blood vessels will increase the risk for high blood pressure and plaque buildup in the arteries. The use of statins has been shown to decrease the incidence of heart attack by 36% and decrease the incidence of stroke by 48%. There is an individualized screening tool your doctor will use to determine which one is best for you.

     

    What Are The Risks?

    For most people statins are very well tolerated. The most important side effect we tell patients to be aware of is muscle aches and pains. This is one of the most common side effects, but still happens in less than 10% of patients. The benefits to the patient in regard to decreasing heart attacks and strokes almost always outweigh the potential risk for side effects. If this occurs the doctor will either lower the dose or try an alternative statin. Severe muscle pain, known as rhabdomyolysis, is a very rare side effect.

    Other side effects that may occur include:

    • Diarrhea
    • Nausea
    • Headache

    These should subside within a week or two of starting the medication

     

    Lifestyle Modifications

    Diet and exercise is important for everyone, but for patients with diabetes  it can help improve blood glucose control, cholesterol levels, and help stabilize blood pressure.

    How Do I Get Started?

    • Go for a 20 min walk 3 times per week
    • Take the stairs instead of the elevator
    • Replace 1 unhealthy snack with fruit or vegetables
    • Increase whole grains and fiber like oatmeal, wheat bread, brown rice, beans, and nuts
    • Replace 1 soda with a bottle of water