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Diabetes and coronary artery disease guidelines released

New guidelines issued by the American College of Physicians (ACP) indicate that people with type 2 diabetes mellitus and coronary artery disease (CAD) or any other risk factor for cardiovascular disease should be taking statins, according to an April 22, 2004, news release from the ACP. The guidelines, published in the April 20, 2004, issue of Annals of Internal Medicine, are aimed at both primary care physicians and patients. Of patients with type 2 diabetes, approximately 80% will develop or die from heart and vessel disease complications.

The guidelines suggest the following.

* Regardless of cholesterol levels, all adults with type 2 diabetes and CAD should take statins.

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* Regardless of cholesterol levels, all adults with type 2 diabetes and another risk factor for CAD--including high blood pressure, high cholesterol, smoking, physical inactivity, or obesity--and premenopausal women with diabetes and another risk factor should take a statin or gemfibrozil.

* Physicians should not delay prescribing a statin for patients with type 2 diabetes until a certain cholesterol level is reached, and they should not treat cholesterol to reach a target level. Patients should remain on at least moderate doses of statin after therapy has begun.

* Only patients with type 2 diabetes who also have liver abnormality or muscle pain or those taking medications that interact with statins need to have their liver function or muscle enzymes monitored routinely.

The ACP based these guidelines on a systematic review of research on patients with diabetes who have CAD or risk factors for CAD and their use of cholesterol-lowering medications. Researchers examined benefits of lipid control in primary and secondary prevention and evidence regarding lowering cholesterol to a target level of low-density lipoprotein.

In the United States, the number of people with type 2 diabetes is increasing. Currently, 18.2 million Americans are thought to have the disease, and an additional 1.3 million adults age 20 or older are diagnosed with the disease each year. Having diabetes is a risk factor for heart disease, as are high blood pressure, high cholesterol, physical inactivity, being overweight or obese, smoking, and older age.

ACP Guidelines: Many Diabetics Should Be Taking Statins (news release, Philadelphia: American College of Physicians, April 22, 2004).

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Diabetes and coronary artery disease guidelines released

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