The number of people living with diabetes mellitus in the U.S. has crossed the 20 million mark, with 1.5 million cases having been diagnosed in 2005 alone. Because nearly 65% of this population will suffer from heart disease or stroke, it is crucial for health care professionals to continually investigate the efficacy of current diabetes treatment regimens.
The “glucocentric” focus of diabetic care may be leading to suboptimal treatment of our diabetic population. Current therapies emphasize and possibly rely on antidiabetic drugs to reduce the morbidity and mortality associated with the disease. However, macrovascular complications continue to be the leading cause of morbidity and direct costs, even in patients who use antidiabetic medications.
New standards of care are being promoted and further studied in order to optimize our current approach. There is a movement toward the consistent inclusion of initial therapy with medications that are known to reduce cardiovascular risks, such as the HMG-CoA reductase inhibitors [statins]. At this point, it is still debatable whether or not all diabetic patients, with and without abnormal lipid profiles, can benefit from additional therapy with a statin. However, many trials have shown clinical benefits in both populations with the use of statins.
To understand the need for statin therapy in diabetic patients, it is first important to understand how lipid abnormalities differ in diabetic and nondiabetic patients and why statins are the lipid-lowering therapy of choice.
The diagnosis of diabetes places patients in a higher risk category for coronary heart disease. Diabetes is a “risk equivalent” for a coronary event such as a myocardial infarction (MI) or stroke. Diabetic patients appear to have poor endothelial function and increased platelet aggregation, which lead to macrovascular complications despite normal lipid concentrations. When lipid abnormalities are present, diabetic patients have been shown to have higher triglyceride levels and lower HDL levels than the nondiabetic population. online canadian pharmacy
The Framingham Offspring Study demonstrated this difference in its study. Lower HDL was present in 43.9% of the diabetic patients versus 20.3% of the nondiabetic patients; the percentages were similar for elevations in triglycerides.
LDL clearance also differs in diabetic patients. Insulin is needed for regulation of LDL receptors and its clearance from the blood; as a result, insulin resistance leads to elevated LDL levels.