Not All Patients With Type 2 Diabetes May Need Statins

Should statin therapy be initiated in all patients with diabetesregardless of their HbA1c and low-density lipoprotein(LDL) cholesterol levels? I have quite a few patients withdiabetes whose HbA1c concentration is below 6% andwhose LDL cholesterol level is below 80 mg/dL. They donot have coronary artery disease (CAD) or peripheralvascular disease. I hesitate to prescribe an additional medicationfor these patients who have already met the criteriafor glycemic control and who have an LDL cholesterollevel below 100 mg/dL.-- Nathalie May, MD
   Philadelphia
In a recent editorial, I argued that the overall efficacyof statin therapy in patients with type 2 diabetes maybe reduced in those who are younger than 40 years,who are premenopausal women, who have no riskfactors for CAD, or who belong to ethnic groups witha low risk of CAD (such as the Chinese, Japanese, PimaIndians, and others).¹ The reduction in efficacy is aresult of the lower absolute number of CAD events inthese populations. I would extend that argument to saythat statin therapy should not be initiated in patientswith diabetes who do not have CAD and who have LDLcholesterol levels of 80 mg/dL or less.However, when a patient with a low LDL cholesterollevel has hypertriglyceridemia, base the decisionto prescribe a statin on the non-high-density lipoprotein(non-HDL) cholesterol level. If such a patient has anon-HDL concentration of less than 130 mg/dL (whichcorresponds to an LDL cholesterol concentration of100 mg/dL), management with proper diet and exerciseis sufficient.-- Abhimanyu Garg, MD
   Professor of Internal Medicine
   Chief, Division of Nutrition and Metabolic Diseases
   Endowed Chair in Human Nutrition Research
   University of Texas Southwestern Medical Centerat Dallas

References:

REFERENCE:1.

Garg A. Statins for all patients with type 2 diabetes: not so soon.

Lancet.

2004;364:641-642.