The American College of Cardiology now recommends that all diabetics age 45-75 use statins, and most payers measure and reward providers for prescribing statins to diabetic patients. Harold Dennis, PA, CHI Saint Joseph Medical Group – Cardiology shares why use by diabetics is beneficial and tips for patients who are not able to tolerate statins.
The greatest benefit of statins to diabetic patients is helping them live longer.
“It is no secret that statins have solidified their place in medicine as the gold standard pharmacologic therapy for the treatment of hyperlipidemia, independent of diabetes. But for our diabetic patients, we know that their 10-Year ASCVD risk is double that of a non-diabetic patient with the same lipid profile, blood pressure and modifiable or non-modifiable risk factors. So, for this patient population, it is difficult to measure the tangible benefit outside of controlling their lipids, but due to their inherent risk, by lowering their LDL, we feel as if we are benefitting our patients. Primary-prevention trials demonstrate that moderate- intensity statin therapy in large cohorts with diabetes mellitus provides significant benefit in decreasing morbidity and mortality associated with first events.”
Don’t give up if your diabetic patient is intolerant to the first statin they try.
“Make sure you are familiar with the various types of statin intolerance – which has evolved over the last 15-20 years – and how it is defined. The National Lipid Association (NLA) is a great resource for this information and for treatment options in these patients. For many patients who cannot tolerate statins, there is not always a ‘silver bullet.’ For these patients, it may take quite a bit of trial and error with various medical therapies (i.e. PCSK9 inhibitors, ezetimibe, niacin, etc.), as well as enforcing a strict diet. However, I would encourage providers to try different statins.”
PCPs should consider other medications that are similarly beneficial for diabetic patients.
“PCSK9 inhibitors (Praluent and Repatha), ezetimibe and niacin can all play a role in treating hyperlipidemia and dyslipidemia.”
It takes a team approach to caring for difficult diabetic patients.
“Don’t be apprehensive to treat these patients aggressively, and don’t rely on other specialties to take the lead. Because of the many comorbidities that can be associated with the diabetic patient, it takes a team of providers to assess them from the 10,000 foot level and then to narrow the scope, honing in on their various comorbid conditions.”