Should all persons with diabetes get statins?

Question

Statins are cholesterol lowering agents that are given to almost all patients with past episode of heart attack, angina, angioplasty or coronary bypass surgery (CABG). Since persons with diabetes are prone to heart disease, they are also often prescribed statins. Should all patients with diabetes be given statins? Thanks for your insight.

Answer 1

In short, no. It is important to understand the meaning of risk and the balance of possible harm caused versus positive effect made by an intervention.

Patients with diabetes have higher risk of cardiovascular disease (CVD) but not all patients with diabetes has CVD. Actually The European cardiovascular disease risk assessment model suggests that diabetes increases the risk of CVD three-fold in males and five-fold in females (1).

The current guideline by European society or cardiology (2) states that:

Statins are recommended to reduce cardiovascular risk in diabetes

Target LDL cholesterol is <2.5 mmol/L, for patients without atherosclerotic disease total cholesterol may be <4.5 mmol/L, with a lower LDL cholesterol target of <1.8 mmol/L (using higher doses of statins) for diabetic patients at very high CVD risk

Moreover, there are studies which show that statin treatment is beneficial regardless of the baseline level of LDL in patients with diabetes. However, "the absolute risk and treatment effect increased with rising cholesterol concentration" as stated in the ESC guidelines. So it is not recommended to prescribe statins to all diabetic patients since the advantage obtained the statin in patients is smaller than the potential harm caused due to side-effects. Hence, ESC has instructed LDL target level above which statin used be used since the benefits are more prominent than the potential harm caused.