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Statins and diabetes

Most guidelines of diabetes care advise people with diabetes who are over the age of 40 years to be on a statin, irrespective of baseline cholesterol or LDL cholesterol. Using a database in Scotland that includes 99% of all people diagnosed with diabetes in Scotland, Jones and colleagues in this issue of Diabetic Medicine (page 640) uncover that as many as one third of people with diabetes do not receive a statin within 2 years of diagnosis. Statin use was lower in men over 65 years and women over 75 years of age compared with a younger age. Furthermore, usage was less in Type 1 diabetes than Type 2 diabetes. The investigators correctly conclude that opportunities to reduce the first occurrence of cardiovascular disease are being missed. Indeed, in a prospective meta-analysis of the efficacy of cholesterol lowering in 18 686 people with diabetes from 14 randomized trials of statins [1], the Cholesterol Trialists’ Collaborators found no heterogeneity of effect for age above or below 65 years, or by sex. The conclusion for clinical care is therefore simple; the vast majority of people with diabetes over the age of 40 years should be on a statin and, if not, the reasons clearly stated. Reference