Almost everyone with diabetes should consider taking a statin drug to lower cholesterol, even if they already have low cholesterol levels, the American Diabetes Association advised on Thursday.
Diabetic patients are at such high risk of heart disease that the statins almost certainly will do them some good, the group said in its latest treatment guidelines.
People with diabetes should all consider taking a daily aspirin, too, the new guidelines say.
“It may well be that everybody with diabetes should be on a statin,” said Dr. Nathaniel Clark, vice-president for clinical affairs for the group. “We know that statins lower low-density cholesterol but they may also have some other qualities that have not been tested,” Clark said in a telephone interview.
An estimated 18 million Americans have diabetes, 90 to 95 percent of them type 2 diabetes. This once was called adult-onset diabetes but it is showing up in children more often now.
Type 1 diabetes is an autoimmune disease caused when the body mistakenly destroys insulin-producing pancreas cells.
Type 2 diabetes is strongly associated with being overweight and sedentary, and arises not from a lack of insulin but from a poor response to insulin. It greatly raises the risk for heart disease, stroke and heart attack and can also lead to blindness and limb loss.
Clark said the Association decided to add statins to the guidelines after seeing the results of a British study, published earlier this year in the Lancet medical journal, that showed people who took statins had a one-third lower risk of stroke.
Their study included adults over the age of 40 whose total cholesterol levels were as low as 135 - considered extremely low by most standards. Among normal healthy people, doctors do not usually consider giving drugs to lower cholesterol until total levels hit 200.
But Clark said diabetics are a special case.
“It is now a consensus that having diabetes is the equivalent in terms of cardiovascular risk of already having had a heart attack,” Clark said. “We are talking about what we would consider a high-risk group.”
Statins are becoming more and more popular with doctors as study after study finds they can lower the risk of a range of heart conditions and may also help patients with multiple sclerosis and Alzheimer’s disease.
Worldwide, 25 million people take statins, but up to 200 million could be eligible.
The drugs are not cheap, however. The United States already spends $12.5 billion on statin drugs, more than any other type of medicine, and the drugs can cause a rare type of side-effect called rhabdomyolysis, which damages muscles.
Revision date: June 20, 2011
Last revised: by David A. Scott, M.D.