January 14, 2015
New Guidelines: All Diabetes Patients Should Be on Statins

Alexandria, VA—All patients with diabetes should take either moderate or high doses of statins to meet new guidelines for cardiovascular risk management, according to a new recommendation from the American Diabetes Association.

That advice would bring management of patients with diabetes in line with recent changes to guidelines for cardiovascular risk management enacted by the American College of Cardiology (ACC) and American Heart Association (AHA), according to the ADA. It is included in the association’s revised Standards of Medical Care, being published in a special supplement to the January issue of Diabetes Care.

The revised treatment guidelines also recommend a less stringent diastolic blood pressure target for people with diabetes.

Last year, the ACC and AHA jointly issued new recommendations for cardiovascular risk management with statins suggested for the vast majority of patients with diabetes. With heart attack or stroke two to four times more likely with diabetes, the ADA now has formalized its recommendation.

A moderate-intensity statin is recommended for diabetes patients who are under 40 years of age or who are between the ages of 40 and 75 and have no additional cardiovascular disease risk factors. Patients with cardiovascular disease or those ages 40 to 75 with additional risk factors should take a high-intensity statin, according to the new standards.

Because people with diabetes are already at high risk for heart disease, the revised Standards of Medical Care call for all people with diabetes to universally take statins.

“The big change here is to recommend starting either moderate or high-intensity statins based on the patient’s risk profile. rather than on LDL level,” said Richard W. Grant, MD, MPH, a research scientist with Kaiser Permanente’s Division of Research who also chairs the ADA’s Professional Practice Committee. “Since all patients with diabetes are at increased risk, it is just a matter of deciding whom to start on moderate versus high-intensity statin doses.”

While the new standards increase the likelihood that diabetes patients will take cholesterol-lowering agents, they also raise the threshold for blood pressure medication, calling for a less stringent diastolic blood pressure goal for people with diabetes of 90 mmHg, up from 80 mmHg.

“While observational studies find that lower blood pressure generally seems to be better, the higher quality randomized trial evidence most strongly supports the treatment target of 90 mmHg,” Grant explained.

The new standards also revised immunization guidelines for older adults to reflect new recommendations by the CDC that people age 65 or older who have not received a pneumonia vaccine receive two separate shots, PCV13 (Prevnar), followed 12 months later by PPSV23 (Pneumovax).

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