If you have diabetes, you’re at a higher risk for heart disease and stroke. This makes it especially important to control other risk factors for cardiovascular problems, such as high cholesterol. Fortunately, there are medications called statins that are effective at lowering low-density lipoprotein (LDL), or “bad” cholesterol.
Which statin is most appropriate if you have diabetes? It depends on your overall cardiovascular risk. However, expert recommendations lean toward a moderate-intensity or high-intensity statin.
There are several different types of statins. Some are more potent than others. They each work a little differently, but they all help lower cholesterol. They do so by interfering with a substance your body needs to make cholesterol in the liver.
There are no longer specific levels of “good” and “bad” cholesterol that everyone should have to be considered healthy. Each person has different individual health factors that determine their risk for developing heart disease.
The ideal levels of cholesterol for you may be different from someone else. In addition to your cholesterol numbers, your age, other health issues, and whether you smoke will determine your ideal cholesterol level and if you need medication.
Recent guidelines presented by the American College of Cardiology and the American Heart Association expanded the number of potential statin users. Doctors used to base their decision to prescribe a statin primarily on a person’s LDL score. Now, other risk factors are also considered. In general, statins are recommended for people who have:
- a diagnosis of cardiovascular disease
- an LDL cholesterol level of 190 mg/dL or higher in people with low risk factors
- diabetes and an LDL of 70 mg/dL or higher
- a 10-year heart attack risk of 7.5 percent or higher and an LDL of 100 mg/dL or higher
In the Standards of Medical Care in Diabetes — 2019, the American Diabetes Association still recommends that all adults with diabetes who are over age 40 take moderate potency statins in addition to lifestyle therapy. Their reasoning is that controlling risk factors will help lower your overall risk for developing heart disease. These risk factors may include:
- high cholesterol
- high blood pressure
- being overweight or living with obesity
- a high level of sodium in your diet
- a low level of physical activity
The fewer risk factors you have, the better your odds of avoiding a heart attack or stroke.
Poorly controlled diabetes poses an additional threat to your cardiovascular health because the extra glucose in your blood can injure your blood vessels. When your blood vessels are damaged, blood flow to the heart and brain can be disrupted. This raises the risk of a heart attack or stroke.
Diabetes can also affect your cholesterol by lowering high-density lipoprotein (HDL), or “good” cholesterol, and raising levels of LDL cholesterol. This is called diabetic dyslipidemia. It can occur even if diabetes is managed.
The right statin for you will depend on your LDL level and risk factors for heart disease. If your cholesterol is only slightly elevated above what your doctor thinks is a good target for you, a less potent statin might be what you need. Pravastatin (Pravachol) and lovastatin (Altoprev) are good lower-potency options.
If you need to combat high cholesterol more aggressively, your doctor may prescribe rosuvastatin (Crestor), which is the most powerful statin, or atorvastatin (Lipitor) at higher doses. Atorvastatin at lower to moderate doses and simvastatin (Zocor) have moderate potency.
Your ability to tolerate a particular statin is also an important consideration. Your doctor may start you on a strong statin and switch the type of statin or lower your dosage, if needed. Some doctors, however, choose to start with the mildest option and work their way up if a patient’s cholesterol numbers don’t come down enough.
Even though statins are usually well-tolerated, they do have some side effects. The main complaint statin users have is muscle pain. This is called myalgia. Switching to a different type of statin or a lower dose often solves the problem.
For people who have diabetes or who are at a higher risk of developing diabetes, there’s another statin side effect that may be of greater concern. Some studies have shown that statin use can lead to a slight increase in blood sugar levels. This may be a concern for a person with diabetes or someone who’s at increased risk of developing diabetes.
The American Diabetes Association recognizes this risk. They make a note of the studies that have shown an association between statins and diabetes in their journal Diabetes Care. However, large studies that have analyzed the results of many individual trials have shown that the absolute risk of developing diabetes is small.
This analysis also showed that the number of events from heart disease (such as heart attack and stroke) that were prevented by statins was much greater than the number of new cases of diabetes.
Managing your cholesterol and diabetes takes more than medications alone. You and your healthcare provider should discuss other ways, such as exercise and diet, to help manage your blood glucose and LDL levels.
If your LDL numbers are high and you have diabetes, statins are still recommended. You should talk to your doctor about:
- your target levels of LDL cholesterol
- the risks and benefits of statins
- the side effects of statins
- how to respond to the side effects of statins
There are several ways to help improve your heart health. If you have diabetes and already have cardiovascular disease or a 10-year increased risk of heart attack, aggressive statin therapy may be one of the best things you can do to help prevent a heart attack or stroke.