Diabetes and Statin

Disease Management Above the Standard

Diabetes is a CHD Risk Equivalent

Most patients are not aware having diabetes alone carries the same high risk as someone with established heart disease who had a heart attack last week - the concept of CHD risk equivalent. How is this possible?

Examine the slide above - a 7 year observational study showing the incidence of heart attack in four population groups. 3.5% for those without diabetes and without heart disease; 18.8% for those without diabetes but with previous heart attack; 20.2% for those with diabetes even without previous heart attack and a very high 45% for those with both diabetes and previous heart attack.

This is the basis for the recommendation that those with diabetes should receive aggressive cholesterol therapy. Controlling diabetes, weight loss and regular exercise are beneficial but they are not enough to prevent heart attack, stroke, vascular death, future need for stent, bypass and hospitalization for angina.

There has been plenty of misinformation about stain and diabetes.

Diabetes and Statin1
Diabetes and Statin2
Safety of Statin vs NSAIDs

The risk of diabetes, defined as elevated fasting blood glucose over 125 mg/dl, is low - one for every 100 patients treated with statin for 10 years or 1 in 1,000 patient-years.

But for every new diagnosis of diabetes, there are 9 patients in whom statin treatment prevented a heart attack, a stroke, a vascular death or a need for stent or heart bypass or hospitalization for angina. No other treatment can match statin or even come close to this magnitude of cardiovascular event reductions. To top it all, generic statin costs pennies per day and 95% of patients can take one of the seven available statins - simvastatin (Zocor), atorvastatin (Lpitor), pravastatin (Pravachol), lovastatin (Mevacor), fluvastatin (Lescol XL), rosuvastatin (Crestor) and  pitavastatin (Livalo). 

Diabetes and Statin3

In the JUPITER Trial, 80% of those who developed diabetes were pre-diabetic before the trial started. This group that was on rosuvastatin and developed diabetes had reduced heart attack, stroke and vascular death. The benefit-to-risk ratio was highly favorable.

This discussion answers the concern about diabetes and statin that was hyped by the press and should ease the patient anxiety over the use of statin.

Look AHEAD Halted due to Futility.pdf

The recent NIH announcement that Look AHEAD trial was halted due futility showed that what seems intuitive proved to be not true. A rigorous ten year scientific study showed that intensive lifestyle intervention program alone in patient with diabetes is not enough. 

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