Nearly All Diabetics Should Be on Cholesterol-Lowering Drugs: Experts

New guidelines from the American Diabetes Association recommend greater statin use

Tuesday, December 23, 2014

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TUESDAY, Dec. 23, 2014 (HealthDay News) -- New guidelines from the American Diabetes Association (ADA) call for giving the cholesterol-lowering drugs known as statins to all people with diabetes to help prevent heart disease.

These new standards bring the association in line with the American College of Cardiology and American Heart Association, which also recommend giving low- or high-dose statins to all people at risk for heart disease, including people with diabetes.

"We agree that the decision to start a statin should be based on a patient's risk," said Dr. Richard Grant, a research scientist at Kaiser Permanente Division of Research and chairman of the ADA's professional practice committee.

"It turns out that patients with diabetes have the same risk as people with heart disease, so all of our patients need to be on statins," he said.

However, Grant said some people with diabetes may not need statins. These include younger, healthier patients and very old patients who have other medical conditions that shorten their life expectancy.

Heart disease is the No. 1 killer of people with diabetes, Grant said. People with diabetes are two to four times more likely to have a heart attack or stroke than people without diabetes, he said.

The increased risk of heart disease in people with diabetes is what was behind the rationale for this year's recommendations on statins, blood pressure and exercise, according to Grant.

"In the old days, all we thought about was sugar, and nowadays we recognize that the leading killer in diabetes is heart disease," he said. "You have to be aggressive in controlling risks."

He added that the ADA standards are updated each year to give doctors the latest guidance for diagnosing and treating both type 1 and type 2 diabetes.

The ADA recommends a moderate statin dose for people with diabetes who are under 40, or 40 to 75 without any other risks for heart disease. A high statin dose is recommended for people with diabetes who have heart disease, and for those between 40 and 75 who have other risk factors for heart disease.

Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City, said, "We have to be aggressive with statins in diabetics."

People with diabetes who are not taking a statin should ask their doctor if they should be taking one, he said.

Mezitis added that people with diabetes should know their cholesterol, blood pressure, average blood sugar level and weight.

The new recommendations also call for a less strict diastolic blood pressure goal of 90 mm Hg, up from 80 mm Hg for most people. The diastolic number is the bottom number in a blood pressure reading.

In addition, the standards recommend that everyone exercise regularly. They also advise that no more than 90 minutes at a time should be spent inactive.

The committee also recommends people with diabetes do resistance training at least twice a week, unless they can't for other medical reasons.

The guidelines for people with diabetes also include:

A new blood sugar standard for children and adolescents -- a hemoglobin A1C of 7.5 or less. This test gives an average of blood sugar levels for the past two to three months, according to the ADA.
A statement that e-cigarettes are not an alternative to smoking or a way to help smokers quit.
A recommendation that people 65 or older get the pneumonia vaccine in two separate shots -- PCV13 (Prevnar), followed 12 months later by PPSV23 (Pneumovax).
Lowering the body mass index (BMI) threshold to 23 for screening Asian-Americans for diabetes. A BMI of 25 is what's usually considered overweight, according to the U.S. Centers for Disease Control and Prevention. But Asians have an increased risk for diabetes at a lower BMI, according to the ADA.

The new guidelines will be published in a supplement to the January 2015 Diabetes Care.

SOURCES: Richard Grant, M.D., M.P.H., research scientist, Kaiser Permanente Division of Research, chairman, professional practice committee, American Diabetes Association; Spyros Mezitis, M.D., endocrinologist, Lenox Hill Hospital, New York City; January 2015 Diabetes Care supplement

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