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News: Prescriber's Letter September 2014

statins 

You’ll hear more about higher doses of statins increasing diabetes risk...partly due to reports of lawsuits in the lay press.

Help put this into perspective for patients.

Explain that statins’ CV benefits STILL outweigh diabetes risk.

For example, there are about 3 more cases of diabetes compared to about 7 fewer CV events for every 1000 patients given atorvastatin ≥ 20 mg versus atorvastatin ≤ 10 mg over two years. 

And diabetes mainly occurs in patients already at high risk...  where a small increase in glucose can push them into the diabetes range.

Follow the new cholesterol guidelines.  And educate patients about healthy lifestyle habits to decrease CV and diabetes risk. 

Patients withOUT diabetes.  Use a high-intensity statin (atorvastatin 80 mg, etc) for patients with CV disease or LDL ≥ 190 mg/dL.

Use a high- or moderate-intensity statin (atorvastatin 20 mg, etc) for patients ages 40 and up with a 10-year CV risk ≥ 7.5%.  Use the new CV risk estimator to determine a patient’s 10-year CV risk. 

Lean towards high-intensity for patients at higher CV risk...or moderate-intensity if drug interactions or statin side effects or interactions are a concern.

Follow the usual diabetes screening...at least every 3 years for patients ages 45 and older or at high risk for diabetes.

Also suggest checking glucose within the first four months after starting a statin...when the risk of diabetes seems to be higher.

Keep a closer eye on patients with diabetes risk factors...obesity, family history, prediabetes (fasting glucose 100 to 125 mg/dL), etc.  These patients have the greatest risk of a statin tipping them over to diabetes.

Patients WITH diabetes.  Use a high-intensity statin if 10-year risk is ≥ 7.5%...and a moderate-intensity statin if risk is < 7.5%. 

Keep in mind, most diabetes patients over age 50 will need a high-intensity statin due to other CV risks such as hypertension.

Statins may slightly increase A1C...by about 0.3% on average.  Adjust diabetes meds if needed.


 

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