Doctors Urge Cholesterol Drugs for Diabetics

Most with type 2 diabetes would benefit, regardless of cholesterol level

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HealthDay Reporter

MONDAY, April 19, 2004 (HealthDayNews) -- Another major medical group is urging that the majority of America's 18.2 million diabetics be placed on cholesterol-busting statins, to lower their risk for heart attack and stroke.

New guidelines from the American College of Physicians (ACP) advise that nearly all diabetics with heart disease or heart disease risk factors -- such as high blood pressure, high cholesterol, obesity or smoking -- be placed on medications such as Crestor, Lipitor, Pravachol or Zocor.

"Patients with diabetes should realize that controlling their blood sugar is important, but it's not the only aspect of diabetes care that's important," explained ACP spokeswoman Dr. Vincenza Snow. "Their blood pressure and their lipid control is also very important and can have a significant impact on their mortality and on their getting sick."

Experts estimate that nearly two-thirds of people with type 2 diabetes will die of either a heart attack or stroke.

The new guidelines appear in the April 20 issue of Annals of Internal Medicine.

Since their introduction, statins have revolutionized the care of patients prone to heart disease. Recent studies have also suggested the drugs may do more than just lower cholesterol.

"The surprising result of those studies was that even if you had near-normal cholesterol to start with, and took a statin drug to lower it even more, you still got benefits," Snow said. "That tells you that it's not just lowering the cholesterol that's good -- it's being on that statin, too. Something else is going on."

For that reason, the new guidelines urge that "all adults with type 2 diabetes and known coronary artery disease should be taking statins, regardless of their cholesterol levels."

Statin therapy is also advised for diabetes patients who have not yet reached the threshold of a heart disease diagnosis but still have unhealthy cardiovascular risk factors such as obesity, physical inactivity, a history of smoking, high cholesterol or high blood pressure.

The ACP also advises that low-dose statin therapy continue even after cholesterol levels have been reduced to normal levels.

A very small percentage of young diabetics are exempt from the guidelines. "Those are the younger diabetics who don't have high cholesterol, who don't smoke or have hypertension," Snow said. But since type 2 diabetes and poor cardiovascular health so often go hand-in-hand, "that's a very select few," she added.

The ACP, which represents most of the nation's primary-care internists, is not the first medical organization to issue these types of guidelines. Dr. Robert A. Rizza, vice president of the American Diabetes Association (ADA), said his group "came to this conclusion a while back, and we're just delighted that everybody is reaching the same consensus."

Neither the ADA nor the ACP is advocating that patients ignore diet and exercise as the best means of maintaining cardiovascular health.

"We know that by keeping lean and fit we prevent many of the problems we're worried about, including diabetes, obesity, heart disease and high blood pressure," added Rizza, a professor of medicine at the Mayo Clinic in Rochester, Minn. "But nevertheless, drugs such as these are important in helping you live a long, healthy life if you have this disease."

Snow agrees. Diet and exercise "can help decrease cholesterol for some, but there's a strong genetic component as well," she pointed out. "That's where we need the drug therapy."

But won't placing 18 million adults on statin medications strain an already overburdened health-care system?

"If you look at the short term, absolutely," Snow said. "But if you're looking at the long term, you're preventing heart attack, hospitalization for heart attack, stroke and disability related to stroke. It seems it would be cost-saving as well as lifesaving."

Snow stressed that maintaining healthy blood sugar is still a top priority for those with diabetes. "We're not saying that controlling your blood sugar isn't important -- it is. But patients with diabetes have to remember their blood pressure and their lipids, too."

More information

To learn more about statins, visit the National Heart, Lung, and Blood Institute. For more information on diabetes and diabetes control, check with the American Diabetes Association.

SOURCES: Vincenza Snow, M.D., FACP, senior medical associate, Department of Scientific Policy, American College of Physicians; Robert A. Rizza, M.D., professor, medicine, Mayo Clinic, Rochester, Minn., and vice president, American Diabetes Association; April 20, 2004, Annals of Internal Medicine

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