When Do Patients With Type 1 Diabetes Need Statins?

Julie Sease, PharmD, BCPS, CDE, BCACP

Disclosures

May 15, 2014

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[1] 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.

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