February 20, 2002
Question from Kailua, Hawaii, USA:
I am 37 years old, I have had type�1 diabetes for 25 years, I have no complications except for slightly elevated microalbumin, and for the past year, I have been taking an ace inhibitor to prevent/ slow down any progression of kidney damage. I am in fairly good control (A1c of 7.1%), I exercise regularly, and I am the correct weight for my height. However, my last cholesterol test was as follows total cholesterol — 171; HDL — 39; LDL — 125; triglycerides — 37, and a new doctor I am seeing wants to put me on a cholesterol lowering agent as a preventative measure. Have any studies been done on the effectiveness of this as a long term preventative measure? Are there any side effects of this type of drug, especially long term? Does a drug like this one interact adversely with ACE inhibitor drugs? Would a cholesterol lowering diet be a better option?
Great questions. It sounds like you are doing well. The American Diabetes Association has recommended individuals with diabetes maintain an LDL cholesterol level less than 100 mg/dl. There has been over 15 years of experience with “statins” (drugs like Lipitor). They have a very potent effect on decreasing cholesterol. In addition, and more importantly, they have had a good track record of preventing cardiovascular events in patients with elevated cholesterol, even when only moderately elevated.
Patients with diabetes also share a beneficial response to these medications. Your ability to decrease LDL-cholesterol through diet is minimal if your diet is already okay. Aggressive diet restrictions can allow you to reduce LDL-cholesterol roughly 10%. This would still leave you with an elevated level. I assure you many patients with diabetes are taking ACE inhibitors and statins at the same time.
The liver enzymes need to be periodically checked as statins can cause a form of drug-induced hepatitis. This is usually mild when occurs, although there have been rare cases where it is more severe. A clinical guide would be to have your liver enzyme level checked two to three times per year, similar to the frequency of checking your hemoglobin A1c.