Statin Therapy and Oral Antidiabetic Drugs: On Adherence and Initiation

March 23, 2012

Patients with type 2 diabetes should be receiving statin therapy, but many patients who would benefit from these agents are not taking them-and not reaching target lipid levels. A recent study shows that timing of statin initiation can make a difference. Here to put the issue into perspective are Drs Christopher Cannon and Payal Kohli.

Current guidelines state that patients with type 2 diabetes mellitus should be receiving statin therapy, and yet many patients who stand to benefit from these agents are not taking them. As a result, they are not reaching recommended lipid targets-a worrisome trend given the rapid rise of lipid-related morbidity and mortality, and the proven lifesaving benefits of statin therapy.

A study published in the March issue of Diabetes and Metabolism Research and Reviews1 looked at the timing of statin initiation-ie, before or after the start of oral antidiabetic drug (OAD) therapy-to see if there was an effect on statin adherence. First, the discontinuation rate for statins was 52% compared with a rate of 15% for OADs.1 The results also indicated that adherence with statins is better if this therapy starts before OAD therapy.1

What’s the basis for these findings and what are the implications for your daily practice? How might these results affect the way you treat your patients with type 2 diabetes?

Here to put this issue into perspective are Drs Christopher Cannon and Payal Kohli. Dr Cannon, a senior investigator with the TIMI Study Group, is editor-in-chief of Cardiosource Science and Quality. He is also Professor of Medicine at Harvard Medical School and Associate Physician in the Cardiovascular Division of Brigham and Woman’s Hospital in Boston. Dr Kohli graduated from Harvard Medical School and completed her internal medicine training in Boston and is scheduled to start her fellowship in cardiovascular medicine at the University of California San Francisco in June 2012.

Adherence with Statin Therapy and Oral Antidiabetic Drugs

Take-home Points

• Statins lower cholesterol levels and are critical for patients with diabetes. Patients who have both diabetes and cholesterol damaging their arteries are at significantly higher risk for heart attack or stroke and must be adherent to these medications.

• Statins are a lifelong therapy-and one of the only medications to date that has been shown to prolong life; patients require education and reinforcement on the importance of taking statin medication as prescribed.

• Polypharmacy is frequently an issue in our patients with diabetes; we need to take extra time with these high-risk patients to explain what each medication is for and the importance of taking all of them regularly.

Reference:
1. Lamberts EJ, Nijpels G, Welschen LM, et al. Discontinuation of statins among patients with type 2 diabetes. Diabetes Metab Res Rev. 2012;28:241-245.