Chronic Disease

Best time to start statins in patients with diabetes depends on the cardiovascular risk model used

Patients with type 2 diabetes often need to lower their cholesterol levels with statin drugs. However, a new study finds that the best time to start such therapy depends on the method used to determine a patient's risk for heart disease. Depending on which risk model is used, there are differences in age and gender when it comes to prescribing statins for the first time. Using clinical data from medical records, researchers identified 683 patients over the age of 40 with at least 10 years of followup. Information was collected on age, gender, number of years with diabetes, different types of cholesterol levels, and blood pressure.

Three different cardiovascular risk models were used to determine the optimal time to start statin therapy. One model is based on patients in the United Kingdom (UKPDS), while another is based on patients in the United States (Framingham). The third model, Archimedes, uses a mathematical model to calculate cardiovascular complications based on several clinical study results.

The best time to start statin drugs depended on the cardiovascular risk model used, as well as the age, gender, metabolic state of the patient, and the societal value associated with quality-adjusted life years. For a selected base case, when the UKPDS model was used, it recommended that all white males with diabetes should start statin therapy. However, for the other two models it was never optimal to start statins in men who were at low risk for cardiovascular problems. Earliest optimal start times for women were 50 years of age for UKPDS, 46 for Framingham, and 40 for Archimedes. In men, the earliest start time was 40 for all three models.

According to the researchers, these observed differences in cardiovascular risk models, age, and metabolic factors contribute to current disagreements as to the best time to start statin therapy in patients with type 2 diabetes. The study was supported in part by the Agency for Healthcare Research and Quality (HS17628).

See "Optimizing the start time of statin therapy for patients with diabetes," by Brian T. Denton, Ph.D., Murat Kurt, M.S., Nilay D. Shah, Ph.D., and others, in the May-June 2009 Medical Decision Making 29, pp. 351-367.

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