eMedinewS Editorial

Health Care 24 Comments

IS Diabetes a Coronary Heart Disease Risk Equivalent?

Patients with coronary heart disease or a CHD risk equivalent who can tolerate statins should be given moderate dose of statins (40 mg of lovastatin, pravastatin, or simvastatin, 20 mg of atorvastatin, or 5 to 10 mg of rosuvastatin) independent of the baseline LDL Cholesterol. That is, even if a patient’s baseline LDL–C is below goal, or is close to goal such that a low dose of a statin would be expected to reduce the LDL–C below the ATP–III goal, one should initiate a statin at a moderate dose.

One should no longer consider all patients with diabetes mellitus to have a CHD risk equivalent. The risk of CHD varies widely in patients with diabetes and is not consistently greater than 20 percent in 10 years.

The following patients with DMare considered to have a CHD risk equivalent

  • Men over age 40 with type 2 DM and any other CHD risk factor, or over age 50 with or without other CHD risk factors
  • Women over age 45 with type 2 DM and any other CHD risk factor, or over age 55 with or without other CHD risk factors
  • Men or women of any age who have had DM (type 1 or type 2) for more than 20 years if they have another risk factor or more than 25 years without another risk factor

Dr KK Aggarwal
Editor in Chief