Statins and Diabetes

The pharmacologic class of drugs known as 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, also most commonly known as "statins," have made a significant impact on the treatment of hypercholesterolemia and the prevention of coronary diseases. Since their debut more than 16 years ago, this class of drugs has revolutionized the treatment of individuals with an increased risk of hypercholesterolemia. Today there are 8 statins on the market (Table).

In recent years, statins have proven to be more than just beneficial cardiovascular agents. Research studies have shown that statins can have a positive impact on other disease states. They have become increasingly popular in various studies for the following diseases:

• Diabetes
• Heart failure
• Cerebrovascular disease
• Alzheimer's disease
• Arthritis
• Osteoporosis
• Multiple sclerosis
• Various cancers (breast, prostate, colorectal)
• Macular degeneration (age-related maculopathy)

It is a known fact that diabetics are at an increased risk for developing some form of cardiovascular disease, in particular coronary artery disease and myocardial infarction. Diabetics need to follow established risk management guidelines for hyperglycemia and coronary disease in order to reduce the chances of developing further complications. Older guidelines recommended that individuals with type 2 diabetes and low-density lipoprotein cholesterol levels >100 mg/dL be prescribed statins.

Recently, the American College of Physicians developed guidelines on managing dyslipidemia, particularly hypercholesterolemia, in patients with type 2 diabetes mellitus. The guidelines were derived from a research study consisting of clinical trials involving 50,000 individuals with type 2 diabetes, including those with some form of microvascular complication and with a particular emphasis on premenopausal women. Specifically, the study made the following verbatim recommendations¹:

• Lipid-lowering therapy should be used for secondary prevention of cardiovascular mortality and morbidity for all patients (both men and women) with known coronary artery disease and type 2 diabetes
• Statins should be used for primary prevention against macrovascular complications in patients (both men and women) with type 2 diabetes and other cardiovascular risk factors
• Once lipid-lowering therapy is initiated, patients with type 2 diabetes mellitus should be taking at least moderate doses of a statin
• For those patients with type 2 diabetes who are taking statins, routine monitoring of liver function tests or muscle enzymes is not recommended except in specific circumstances

The new guidelines suggest that individuals over 55 years of age with type 2 diabetes and younger individuals with type 2 diabetes who have at least one cardiovascular risk factor should be taking a statin drug.²

Whereas the research regarding statin usage in many other disease states appears to be encouraging to many, more research still needs to be done. Overall, statins are relatively safe agents. Although some in the health care industry may see statins as "wonder drugs," it is important to review the side effects associated with these agents to determine their appropriateness for each individual patient when prescribing.

More information about statins can be found at the National Heart, Lung, and Blood Institute Web site (www.nhlbi.nih.gov) and at the various drug manufacturers' Web sites.

Ms. Terrie is a clinical pharmacy writer based in Slidell, La.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Stahl, Pharmacy Times, 241 Forsgate Drive, Jamesburg, NJ 08831; or send an e-mail request to: astahl@mwc.com.