Are cholesterol medications overprescribed for patients with type 2 diabetes?

Kathleen Blanchard's picture
Type 2 diabetics may risk harm from cholesterol lowering drugs, finds VA study.
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Researchers from the VA Ann Arbor Healthcare System (VAAAHS) and the University of Michigan Health System highlight the importance of taking an individualized approach when it comes helping people with diabetes minimize their risks for heart disease. Some patients with type 2 diabetes may not need high dose cholesterol lowering drugs that can have serious adverse effects.

Authors of a new study emphasize the potential harm that can come from exposing patients with type 2 diabetes to high dose medications that can lead to overtreatment and harm when a ‘one size fits all’ approach is used.

In their study, the researchers found nearly 14 percent of patients with diabetes; with no history of heart disease, may have been taking high dose cholesterol lowering medications known as statins that can cause muscle pain, liver damage, higher blood glucose levels, memory loss and liver disease.

Senior author Eve Kerr, M.D., director of the Center for Clinical Management Research at the VAAAHS, professor of internal medicine at the U-M Medical School and a member of the U-M Institute for Healthcare Policy and Innovation said in a press release, “We want patients to get the treatment they need to prevent heart attacks and cardiovascular issues but we don’t want to expose them to additional treatment risks without strong evidence of the benefits.”

The report that appears in the journal Cardiovascular Quality and Outcomes suggests physicians who want to deliver high quality care to patients with diabetes can become overly aggressive with prescribing medications by using a standardized approach instead of individual treatment.

“We need to move away from a one-size-fits-all performance measure that misses the point of providing appropriate treatment”, Kerr says.

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People with diabetes over age 50 are especially at risk for heart disease. A common goal is to keep LDL cholesterol levels believed to promote atherosclerosis less than 100 mg/dl.

But the authors say there is recent evidence that not all people with diabetes need to keep cholesterol levels at a set value. Another recent study suggested not all type 2 diabetics carry the same risks for heart disease, supporting the notion that treatment for preventing heart disease complications should be based on individual risk factors.

“The study reveals that we may have both underuse and overuse of statins and should invigorate efforts to make sure that each patient has the opportunity to be treated in a personalized way that is best given their risk profile,” says Circulation Editor and Director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation Harlan M. Krumholz, M.D. in a media release.

The investigation included over 960,000 veterans with type 2 diabetes treated in primary care clinics from July 2010 to June 2011. Most of the patients were receiving appropriate treatment, but the author concluded "...many patients are potentially overtreated with high-dose statins."

The study authors say individualized treatment for cutting diabetes heart disease risks is possible because of access to patient health information with electronic medical records. The finding suggests it can be harmful for patients when doctors take a ‘one size fits all’ approach for prescribing statins for people with type 2 diabetes. The FDA recently issued new guidelines and warnings for cholesterol lowering drugs, based on concerns over side effects.

Citation:
Circ Cardiovasc Qual Outcomes. 2012
doi:10.1161/CIRCOUTCOMES.112.966697

Image credit: Morguefile

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Comments

Dr Mercola writes; "One in four Americans over the age of 45 are now taking a statin drug, despite the fact that there are over 900 studies proving their adverse effects, which run the gamut from muscle problems to diabetes and increased cancer risk. Vitamin C reduces cholesterol without any side effects. It is one of the most effective repair molecules in the artery wall. Artery walls are weakened by insufficient Vitamin C. Vitamin C strengthens cell walls and stops them leaking. Arteriosclerosis is plaque consisting primarily of apo(a) that the body uses to try to plug up weakened arterial walls. Taking extra Vitamin C repairs the arterial walls making them slippery so that plaque is loosened and reabsorbed. HDL picks up plaques, returning them to the liver for degradation. Vit C and E increase HDL levels. Apo(a) is not reduced by cholesterol reducing drugs or by a low fat diet. Only Vitamin C, E, or B3, reduce apo(a). Lysine and proline help to reduce the stickiness. More than 40 studies show that 2-3 Gm of Vitamin C daily can lower cholesterol by 50% - 70%. It is a cheap, effective, natural, non damaging remedy that is environmentally friendly and does not have negative effects on diabetics.
I'm not a fan of your source Hans. :)
We share that sentiment! I am not a fan of yours!
Oh my! Well the cat is out of the bag. But I believe you misread. I was referring to your source re: cholesterol, which is Dr. M - not you.. I'm sorry to hear that you read my articles, frequently contribute, yet are not a 'fan'. Since I don't write opinion articles, but report what researchers find, I won't take that personally. Plus, you don't know me personally. :) Re: your comment in general though - This finding supports that there can be side effects of the medications, especially in higher doses. It's important for patients to follow up for frequent blood testing for liver function and report any side effects they might be having. It's also important to know what those are by taking time to learn and accept counseling offered at the pharmacy. Some people cannot tolerate statins and others have no problems. I think lifestyle changes are always a better option for treatment. Unfortunately, that's difficult for so many people. Peace.
I feel you misread my reply! I meant I am not a fan of your source. I am a fan of yours truly, and enjoy reading your articles. I comment when I have, on our files, information or research that does not agree with your source. And, as I mentioned before, where does it lead to? More drugs rather than finding causes? That is my take away. But I am a fan of yours. I wish more people would comment so we could have a lively discussion about the contents of the articles.
LOL - It's very clear now what you meant. :) I agree about more active discussion too. I think drugs should be for short-term use - again, somewhere in the middle.
I am not a fan of Dr M either, Only the top two or three lines refer to him. I read his articles, and comment on them, I comment on a variety of articles in different forums and e health papers. The Vitamin C reference is mine and sources include Dr. Matthias Rath, and Dr. Linus Pauling.