Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines.
- MeSH
- anticholesteremika aplikace a dávkování škodlivé účinky farmakologie terapeutické užití MeSH
- diabetes mellitus 2. typu epidemiologie etiologie prevence a kontrola MeSH
- dospělí MeSH
- glykovaný hemoglobin analýza MeSH
- hodnocení rizik MeSH
- kardiovaskulární nemoci epidemiologie prevence a kontrola MeSH
- kohortové studie MeSH
- komorbidita MeSH
- LDL-cholesterol krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- metaanalýza jako téma MeSH
- multicentrické studie jako téma statistika a číselné údaje MeSH
- náchylnost k nemoci MeSH
- omezení příjmu potravy krev MeSH
- pozorovací studie jako téma MeSH
- prediabetes epidemiologie MeSH
- předpověď MeSH
- rizikové faktory MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- statiny aplikace a dávkování škodlivé účinky farmakologie terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
The purpose of this review is to present recent information on lipid lowering in diabetes mellitus. New information from randomized clinical trials will be discussed together with implications for clinical practice. Residual risk persists despite statin therapy and additional approaches, particularly in relation to increasing HDL cholesterol will be discussed. RECENT FINDINGS: Recent RCTS have shown evidence of benefit and safety of more intensive LDL cholesterol lowering in patients with diabetes and established cardiovascular disease supporting guidelines for a more intensive LDL goal of therapy. A recent meta-analysis has confirmed benefit on major coronary events and ischaemic stroke in many diabetic patient subgroups, including those with type 1 disease.Despite statin treatment, cardiovascular disease residual risk remains high. After LDL the next lipoprotein goal is to increase HDL. Although there has been disappointment with the first cholesterol ester transfer protein inhibitor, there is encouraging evidence that increasing HDL with the peroxisome proliferator activator receptor (PPAR) gamma agonist, pioglitazone and nicotinic acid derivatives may contribute beyond statin therapy. SUMMARY: In summary the benefits of statin therapy in diabetes has been confirmed and extended such that the overwhelming majority of diabetic patients should be considered for this therapy. Increasing HDL might provide additional benefit that may further reduce cardiovascular disease risk.
