Is this new protocol for treating diabetes

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.