|The American Diabetes Association has revised its guidelines for use of statins in people with diabetes to align with those issued in 2013 by the American College of Cardiology and the American Heart Association.
The change was included in the ADA's 2015 update of the Standards of Medical Care in Diabetes, published every January as a supplement to Diabetes Care. Like the still-controversial ACC/AHA guidelines, the new ADA recommendation focuses on statin use by risk profile rather than LDL-cholesterol measurement. Because diabetes itself is a major risk factor for cardiovascular disease, the ADA recommends statin use for nearly everyone with diabetes and provides further guidance on starting doses.
However, the ADA does not strongly endorse the also-controversial ACC/AHA "risk calculator" and does advise measuring LDL as needed to monitor adherence. The new ADA statement also acknowledges major evidence gaps with regard to lipid lowering, such as for patients younger than 40 or older than 75 years and those with type 1 diabetes.
"We changed pretty substantially our recommendations from the prior year. We basically more or less adopted what ACC/AHA said, with caveats," said ADA professional practice committee chair Richard W Grant, MD, a research scientist at Kaiser Permanente, Oakland, California and the University of California, San Francisco.
In addition to the new statin guidelines, other 2015 revisions to the ADA Standards include a change in the body mass index (BMI) cut point for screening Asian Americans for prediabetes and diabetes, new targets for diastolic blood pressure and for the low end of the glycemic range, a new recommendation for combating sedentary time, and a stance against e-cigarettes. The format of the Standards itself is also new this year, released as a single document rather than separate position statements.
|"Substantial" Change in Statin Guidance
Dr Grant said that of all the 2015 revisions, the new statin recommendation was the most difficult for ADA's 14 practice-committee members. "That's the thing we struggled with the longest and the most. We've always checked LDL levels and, on the basis of LDL-cholesterol levels, started and adjusted the dose of statins to get under a certain level…That's been tattooed in every doctor's brain for the past 15 years or so."
We've always checked LDL levels… That's been tattooed in every doctor's brain for the past 15 years