People with type 2 diabetes have a higher prevalence of lipid abnormalities, contributing to high risk of atherosclerotic cardiovascular disease (ASCVD). Statin can be used in patients with diabetes for primary and secondary prevention of ASCVD events.
A recent drug utilization review (DUR) showed that more than a third of our members with diabetes between the ages of 40 and 75 are currently not taking any statins. Please review the guidelines below and consider whether statin therapy may be appropriate for your patients.
Initiating statin therapy
The American Diabetes Association (ADA) standards of care for diabetes recommend that statin therapy should be initiated in individuals with diabetes and other cardiovascular risk factors after careful assessment (https://diabetesjournals.org/care/article/46/4/898/148368/Erratum-10-Cardiovascular-disease-and-risk).
- For patients ages 40 years and older with diabetes: Use moderate-dose statin therapy.
- For patients ages 40 to 75 with diabetes and a higher cardiovascular risk (including those with one or more ASCVD risk factors): Use high-intensity statin therapy to reduce LDL cholesterol by ≥50% of baseline and target an LDL cholesterol goal of <70 mg/dL.
- For patients with diabetes who have already had an ASCVD event: High-intensity statin therapy is recommended to target an LDL cholesterol reduction of ≥50% from baseline and an LDL cholesterol goal of <55 mg/dL.
Managing statin-associated symptoms
The 2018 American Heart Association and American College of Cardiology Guidelines on the Management of Blood Cholesterol recommend a comprehensive approach to patients who experience statin-associated symptoms, with the clinician reassessing, discussing and encouraging rechallenge as the initial approach unless side effects are severe (https://doi.org/10.1161/CIR.0000000000000625).
Some options to alleviate statin-related muscle pain include:
- Statin dose reduction (reduced dose and/or 3 times weekly versus daily dosing).
- Switching to an alternate statin or hydrophilic statin (e.g., pravastatin, rosuvastatin).
- Combining an alternate statin with ezetimibe.
