Sun Sentinel Broward Edition

Is this new pro­to­col for treat­ing di­a­betes

- Write to Dr. Roach at ToYourGood­Health @med.cor­nell.edu. Dr. Keith Roach

Dear Dr. Roach: I re­cently was seen by a fam­ily prac­ti­tioner af­ter not hav­ing seen a doc­tor in 15 years, ex­cept at ur­gent care. I have Type 2 di­a­betes, and my re­cent A1c read­ing was 7.2. My choles­terol read­ings, both good and bad, were av­er­age.

The doc­tor men­tioned to me that as soon as I go on Medi­care (in 60 days), she wants me to take a statin drug. She in­di­cates that this is “pro­to­col” now for di­a­betes (as a pre­ven­tion ther­apy). The side ef­fects of statin drugs seem to me too danger­ous to con­sider this when my choles­terol lev­els are good. There is heart dis­ease (from my fa­ther) in the fam­ily. Thoughts? — I.M.

Statin drugs re­duce the risk of heart attack, and prob­a­bly stroke, in peo­ple who are at higher-than-av­er­age risk for th­ese con­di­tions. The higher the risk, the more ben­e­fi­cial the med­i­ca­tions are So, statin drugs are not rec­om­mended for those at low risk, as the benefits are un­likely to out­weigh the pos­si­ble harms.

There are many risk fac­tors for heart dis­ease. High choles­terol is one, but high blood pres­sure, smok­ing, fam­ily his­tory and poor diet and ex­er­cise also are im­por­tant risk fac­tors. Di­a­betes, both Type 1 and Type 2, in­creases risk for heart dis­ease, and so must be con­sid­ered by your doc­tor when mak­ing the de­ci­sion to rec­om­mend a statin. The risk is largely determined by how long you have had your di­a­betes and how well it has been con­trolled.

There are sev­eral cal­cu­la­tor tools avail­able to es­ti­mate an in­di­vid­ual’s risk for heart attack and death based on risk fac­tors, although the most com­monly used one re­cently has been shown to sig­nif­i­cantly overestima­te risk. In my opin­ion, this de­ci­sion needs to be per­son­al­ized, and pro­to­cols — how­ever well-mean­ing and well-done — can­not be sub­sti­tuted for in­di­vid­ual judg­ment based on know­ing the per­son, along with his or her risks and fears.

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