Statin Use for Diabetics (SUPD): Aaron Satran, M.D. Shares Tips
Tuesday, March 19, 2019
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. Aaron Satran, M.D.
, KentuckyOne Health Cardiology Associates shares why statin use by diabetics is beneficial and tips for patients who are not able to tolerate the medication.
Statin use by diabetic patients is almost universally beneficial:
“By definition, the majority of patients with diabetes are at an intermediate to high risk of future cardiovascular events, and multiple randomized controlled trials of even moderate-dose statins in diabetic patients have all demonstrated a marked (approximately 25%) reduction in these future cardiovascular events (ie. heart attack or stroke). Statins are thought to stabilize existing plaque, reduce the propensity for clotting (decreased thrombogenicity), increase arterial relaxation (improvement in endothelial function), and possibly contribute to plaque regression.”
For patients who struggle with tolerance to statin use:
“If patients are unable to tolerate statins (most commonly due to myalgias), the statin should be temporarily stopped. If the symptoms are truly related to use of a statin, then that statin restarted at a lower dose, or an alternate statin can be chosen. If symptoms persist, then the statin can be given every other day or switched to a lower potency statin. Finally, for those who are intolerant of all statins, treatment with PCSK9 inhibitors (such as evolocumab or aliocumab) and/or ezitimbide should be considered. A good clinical reference is the Statin Associated Muscle Symptoms clinical index (SAMS-CI), which can be found on the American College of Cardiology website.” Reference Tool: SAMS-CI
Be persistent with your diabetic patients:
“In addition to appropriate pharmacologic therapy, lifestyle modification (appropriate diet, daily exercise, weight loss, smoking cessation) is crucial for the treatment of diabetes.”