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.
Original posting 20 Feb 2002
Posted to Other Medications
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