Statin Therapy for Patients with Diabetes | January 2019 | Clinical Corner

Adults 40–75 years of age with diabetes, who do or do not have clinical atherosclerotic cardiovascular disease (ASCVD), should be started on a statin for primary and secondary prevention of ASCVD regardless of lipid status.

Medications One of the following medications must have been dispensed. Note: The active ingredients are limited to oral formulations only.
Drug Category	Medications
Statin medications	* Lovastatin * Fluvastatin * Pravastatin * Simvastatin * Rosuvastatin * Atorvastatin * Pitavastatin
Statin combination products	* Atorvastatin / amlodipine * Atorvastatin / ezetimibe * Lovastatin / niacin	* Simvastatin / ezetimibe * Simvastatin / niacin * Simvastatin / sitagliptin
Standard exclusion(s)	Timeframe
* Patients in hospice * End-stage renal disease (ESRD)	* Any time during the measurement year * Any time during the measurement year or the year prior to the measurement

1. For diabetics without ASCVD, use MODERATE INTENSITY statin for primary prevention1.
2. For diabetics “with” ASCVD, use HIGH INTENSITY statin for secondary prevention2.
3. Low Intensity statins are not recommended unless unable to tolerate moderate or high intensity.

High-, Moderate-, and Low-Intensity Statin Therapy
High Intensity	Moderate Intensity	Low Intensity
Daily dose lowers LDL-C on average by ≈ ≥50%	Daily dose lowers LDL-C on average by ≈ 30% to <50%	Daily dose lowers LDL-C on average by <30%
Atorvastatin 40-80 mg Rosuvastatin 20-40 mg	Atorvastatin 10-20 mg Rosuvastatin 5-10 mg Simvastatin 20-40 mg Pravastatin 40-80 mg Lovastatin 40 mg Fluvastatin XL 80 mg Fluvastatin 40 mg bid Pitavastatin 2-4 mg	Lovastatin 40 mg Fluvastatin XL 80 mg Fluvastatin 40 mg bid Pitavastatin 2-4 mg

References:

1. Cochrane Database Syst Rev. 2013:CD004816
2. Diabetes Care 2006 Jun; 29(6): 1220-1226

** Promote Statin Use in Diabetics **

If you have any questions, please contact Dr. Preston Thomas, Associate Medical Director at 248-484-4980 or Preston.Thomas@McLaren.org