Statins, as HMG-CoA reductase inhibitors, play a crucial role in managing dyslipidemia, particularly in patients with diabetes mellitus. They are highly effective in reducing low-density lipoprotein cholesterol (LDL-C) levels, a primary target in the prevention of atherosclerotic cardiovascular disease (ASCVD).
Cardiovascular risk reduction
- Statins have been shown to significantly reduce the risk of major cardiovascular events in patients with diabetes, including myocardial infarction, stroke, and cardiovascular mortality
- In patients with type 2 diabetes, statin therapy has been found to be cost-effective for the primary prevention of major coronary events
- Statin therapy is recommended for patients with diabetes and ASCVD to target an LDL-C reduction of ≥ 50% from baseline and an LDL-C goal of < 55 mg/dL (<1.4 mmol/L)
LDL-C reduction
- Statins are recommended as first-line LDL-C-lowering treatment in patients with diabetes and above-target LDL-C levels
- High-intensity statin therapy is recommended to reduce LDL-C by ≥ 50% of baseline and to target an LDL-C goal of < 70 mg/dL (<1.8 mmol/L) in 40-75-year-old patients with diabetes at higher cardiovascular risk, including patients with ≥ 1 ASCVD risk factors
Specific patient populations
- Statin therapy is recommended irrespective of the cardiovascular risk score to reduce cardiovascular risks in adult patients with type 1 diabetes (T1DM) and/or with a duration of diabetes > 20 years and/or microvascular complications
- Statin therapy is also recommended for adult patients with T1DM with obesity, or with high triglycerides and low HDL-C, irrespective of the cardiovascular risk score
- For patients with type 2 diabetes (T2DM) and compensated cirrhosis from MASLD, statin therapy is recommended for cardiovascular risk reduction as clinically indicated, with caution advised for patients with decompensated cirrhosis
Adverse effects
- While statins have been associated with a moderate dose-dependent increase in new diagnoses of diabetes, any theoretical adverse effects on cardiovascular risk from these small increases in glycaemia are already accounted for in the overall reduction in cardiovascular risk seen with statin therapy
- The benefits of statin therapy in reducing cardiovascular risk outweigh the potential risk of developing type 2 diabetes
In conclusion, statins offer significant benefits for patients with diabetes, including reduction in LDL-C levels, decreased risk of major cardiovascular events, and improved outcomes in specific patient populations. While there is a potential risk of new-onset diabetes with statin use, the overall cardiovascular benefits of statin therapy outweigh this risk.