Statins for everyone?   (November 10, 2008)

Statins (also known as HMG-CoA reductase inhibitors) are a class of medications used to lower cholesterol levels in people with elevated cholesterol levels. These drugs are very frequently recommended in people with and without diabetes, as they are very effective in both lowering cholesterol and decreasing the rate of cardiovascular complications. There are several statins on the market, and at least one that was taken off the market (cerivastatin) because of an unduly high rate of a side effect affecting the muscles, rhabdomyolysis. Some of the earlier statins are now available in less-expensive generic versions, and others are only available in brand-name (and more expensive) versions.

A recent article in the New England Journal of Medicine (Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein) provides the results of a large (17,802 person), fairly short duration (median follow-up of 1.9 years, maximum of 5.0 years) trial giving one of the statins (rosuvastatin, brand name Crestor) to people with normal cholesterol levels but who had elevations of a lab test for inflammation (high-sensitivity C-reactive protein, abbreviated HSCRP). The researchers found that rosuvastatin significantly reduced the incidence of major cardiovascular events (myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes).

This study has caught the attention of the media, and some high-profile cardiologists have weighed in about their interpretation of the results. For example, the LA Times quotes the president of the American College of Cardiology as saying that these findings "really change what we are going to do in the future... This targets a patient group that normally would not be screened or treated to prevent cardiovascular disease."

But for people with diabetes, ho-hum. So what? This is old news.

Back in 2003, there was a study known as the Heart Protection Study, which concluded that most adults with diabetes should be taking a different statin (simvastatin) even if they have normal cholesterol levels and no evidence of heart disease. That study, published in the Lancet, found that statin drugs cut the risk of heart attacks, strokes and the need for angioplasty or bypass surgery in people with diabetes by one-third.

So, although it's exciting to find that "normal" folks with normal cholesterol levels and elevated  HSCRP will benefit from long-term use of a statin, it should not really be news for people with diabetes.

Based on both the newly-published study plus the earlier one from 2003, it seems reasonable to conclude that most people with diabetes should be on a statin. If you have diabetes and have not heard from your physician about possible use of a statin, please ask your physician to review the recent information in the NEJM, and the older information from the Lancet.