July 5, 2006
Question from Raleigh, North Carolina, USA:
At my yearly physical, I received the following laboratory test results: A1c - 6.7; Triglycerides - 52; HDL - 58; LDL - 120; Total Cholesterol - 188; CHOL/HDLC Ratio - 3.2. My urine microalbumin test was normal. I am a 31 year old man in otherwise good shape (not overweight, exercise fairly regularly, etc.). I have controlled my blood sugar with diet and exercise for over five years. My doctor said we may consider Zocor, 20 mg, at bedtime to get the LDL under 100. I asked if I could try diet and exercise modifications for the LDL level since my other levels were okay. He said that would be fine, but studies have shown diabetics on Zocor had fewer cardiac events than those not on Zocor. I have a follow-up with him in six months. I am trying to weigh the pros and cons of the Zocor. Is it safer to hold off for six months and try lifestyle changes and re-check or should I go ahead and start the Zocor? As with any medications, I know there are risks of side effects.
Your question is a common one and an important one. The Heart Protection Study, published in 2004, demonstrated that patients with type 2 diabetes, even with LDL-cholesterol levels less 100 mg/dl (yours is 120 mg/dl), had fewer cardiac events than those who were not treated. Therefore, you should probably be on a statin drug (of which Zocor is one and the one used in the Heart Protection Study). If you are asking me, my preference is to treat patients with type 2 diabetes and that LDL-c of 120 with Zocor or another statin. I would also challenge you to look at your A1c of 6.7% and think about the value in a different way. Why not take metformin and attempt to normalize the A1c value? There is no safe level of hyperglycemia.