When Do Patients With Type 1 Diabetes Need Statins?
When should a statin be started in a patient with type 1 diabetes?
The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults was published in November 2013. This guideline recommends that statin therapy be considered if a patient falls into one of 4 "statin benefit groups."
The 4 groups are:
1. Patients with clinical atherosclerotic cardiovascular disease (ASCVD). which includes acute coronary syndromes, a history of myocardial infarction, stable or unstable angina, a history of coronary or other arterial revascularization, stroke, transient ischemic attack, and peripheral arterial disease due to an atherosclerotic cause
2. Patients with no prior history of ASCVD but a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dL
3. Patients with diabetes (type 1 or type 2) and no history of clinical ASCVD who are between the ages of 40 and 75 years with a LDL-C level between 70 and 189 mg/dL
4. Patients ages 40-75 years with no prior history of ASCVD or diabetes who have an LDL-C level between 70 and 189 mg/dL and a 10-year estimated ASCVD risk ≥ 7.5%.
Furthermore, the guidelines recommend screening with a fasting lipid panel and ASCVD 10-year risk calculation in adults 21 years of age or older.
To apply this guideline to a patient with type 1 diabetes would mean recommending screening beginning at age 21 and use of a statin if one of the following is present in the patient:
1. A history of clinical ASCVD (recommend high-intensity statin therapy such as atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily)
2. LDL-C level ≥ 190 mg/dL (recommend high-intensity statin therapy)
3. Between the ages of 40 and 75 years and have a LDL-C level between 70 and 189 mg/dL (ASCVD ≥ 7.5%: recommend high-intensity statin therapy; ASCVD < 7.5%: recommend moderate-intensity statin therapy such as atorvastatin 10-20 mg daily, rosuvastatin 5-10 mg daily, or pravastatin 40-80 mg nightly)
Additionally, if the patient with type 1 diabetes does not fall into one of these 3 categories, then:
4. Calculate their 10-year ASCVD risk; if it is ≥ 7.5% and their LDL-C is between 70 and 189 mg/dL, consider initiating a moderate- to high-intensity statin regimen.
Question
When should a statin be started in a patient with type 1 diabetes?
|
|
Response from Julie Sease, PharmD, BCPS, CDE, BCACP Associate Professor, Presbyterian College School of Pharmacy, Clinton, South Carolina; Clinical Pharmacy Specialist, Good Shepherd Free Medical Clinic, Clinton, South Carolina |
The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults was published in November 2013. This guideline recommends that statin therapy be considered if a patient falls into one of 4 "statin benefit groups."
The 4 groups are:
1. Patients with clinical atherosclerotic cardiovascular disease (ASCVD). which includes acute coronary syndromes, a history of myocardial infarction, stable or unstable angina, a history of coronary or other arterial revascularization, stroke, transient ischemic attack, and peripheral arterial disease due to an atherosclerotic cause
2. Patients with no prior history of ASCVD but a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg/dL
3. Patients with diabetes (type 1 or type 2) and no history of clinical ASCVD who are between the ages of 40 and 75 years with a LDL-C level between 70 and 189 mg/dL
4. Patients ages 40-75 years with no prior history of ASCVD or diabetes who have an LDL-C level between 70 and 189 mg/dL and a 10-year estimated ASCVD risk ≥ 7.5%.
Furthermore, the guidelines recommend screening with a fasting lipid panel and ASCVD 10-year risk calculation in adults 21 years of age or older.
To apply this guideline to a patient with type 1 diabetes would mean recommending screening beginning at age 21 and use of a statin if one of the following is present in the patient:
1. A history of clinical ASCVD (recommend high-intensity statin therapy such as atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily)
2. LDL-C level ≥ 190 mg/dL (recommend high-intensity statin therapy)
3. Between the ages of 40 and 75 years and have a LDL-C level between 70 and 189 mg/dL (ASCVD ≥ 7.5%: recommend high-intensity statin therapy; ASCVD < 7.5%: recommend moderate-intensity statin therapy such as atorvastatin 10-20 mg daily, rosuvastatin 5-10 mg daily, or pravastatin 40-80 mg nightly)
Additionally, if the patient with type 1 diabetes does not fall into one of these 3 categories, then:
4. Calculate their 10-year ASCVD risk; if it is ≥ 7.5% and their LDL-C is between 70 and 189 mg/dL, consider initiating a moderate- to high-intensity statin regimen.