Starting statin therapy: Things to consider and discuss
| For all patients when considering statin therapy: |
| Screen to determine baseline glycemic status |
| Consider nonstatin therapies to lower cholesterol (resins, ezetimibe, bempedoic acid) |
| Consider variables associated with an increased risk of diabetes, including potentially adverse antihypertensive drugs (thiazides and beta-blockers) and potentially beneficial antihypertensive drugs (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) |
| When starting statin therapy in patients without diabetes, discuss: |
| The possibility of developing diabetes mellitus |
| Types and doses of statins |
| Benefits of statins in reducing the risk of cardiovascular disease generally far outweigh risks on the development of new-onset diabetes |
| For patients with diabetes mellitus, discuss: |
| The possible adverse effects of statins on glycemic control, which are small |
| The benefits of statins in reducing the risk of atherosclerotic cardiovascular disease, which significantly outweigh a small increase in hemoglobin A1c |
| Adverse glycemic effects of statins can be mitigated by glucose-lowering therapies, especially those with favorable cardiovascular profiles |
Based on recommendations from references 9, 40, and 41.