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.