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Simply having diabetes -- even without any other risk factors -- significantly increases your risk of heart disease. In addition, people with diabetes are far likelier to die from a heart attack than those without diabetes.
That is why the federal government's guidelines for managing cholesterol calls for people with diabetes to maintain a lower low-density lipoprotein (LDL) cholesterol level -- less than 100 milligrams per deciliter (mg/dL) -- than any other group. And studies find that people with diabetes who take statins can reduce their risk of nonfatal heart attacks and death from cardiovascular disease from 20-40%.
The national cholesterol guidelines call for starting drug therapy in people with diabetes when their LDL is 130 mg/dL or higher even with lifestyle changes such as exercise, diet and weight loss. The American Diabetes Association (ADA), however, recommends adding statin therapy to lifestyle changes regardless of baseline cholesterol levels in people with diabetes who already have cardiovascular disease, or in those over age 40 who have one or more other cardiovascular disease risk factors.
Because the overwhelming majority of people with diabetes die of heart attacks, it's now the "standard of care" to have all diabetes patients take a cholesterol medication called a statin, even if their cholesterol is absolutely on target.
If your cholesterol is perfect, you'll take a low dose. If it's less than perfect, you'll take a higher dose. And even if everything looks like it's on target, you still need to have your doctor run a lipid panel every year. We're human, and biological systems are inherently in a state of change. The right amount of statin this year may not be the right amount next year.
There have been many studies showing the benefit of cholesterol lowering with statin drugs in those with diabetes, and because the data are so strong and the risk of heart disease is so high in people with diabetes, the American Diabetes Association recommends that a statin drug be used in any person with diabetes and known heart disease or any person with diabetes and another risk factor for heart disease, such as high blood pressure, even if the cholesterol levels are normal. Although less than 100 is regarded as normal, many doctors consider an LDL of less than 70 to be the target with statin treatment for those with diabetes because pushing the LDL lower provides even more benefit.
This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.