@caw wrote:
I am a practicing pharmacist of 34 years. I have never posted before, but just wanted to share some information.
Having diabetes can lead to microvascular and macrovascular complications.
MICROvascular complications occur when the diabetes affects the small blood vessels . The microvascular complications affect organs such as your eye and kidneys. That's why diabetes can lead to blindness and kidney complicaions. If you control your diabetes and have an A1C at goal, you CAN mitigate THESE complications.
Diabetes causes MACROvascular complications --it affects the large blood vessels which is why people with diabetes are 2 to 4 times more like to suffer a stroke or heart attack. Lowering your blood sugar does NOT mitigate THESE effects. That is why we are aggressive in diabetics and treat their blood pressure, put them on statins and work to get them to stop smoking. These interventions DO decease the risk of stroke and heart attack.
When statins first came on the market, we knew the statins lowered cholesterol and, people who were put on statins had less strokes and heart attacks.( often referred to as having an event). So, we treated to lower cholesterol numbers thinking that was what making the difference. Problem is, diabetics with "good" numbers were having an event. So why.....
The cholesterol of a diabetic has a different make -up then a non diabetic. It is denser and more likely to accumulate in blood vessels. Diabetics also have a difference in their endothelium (lining of the blood vessel). Diabetics have an increase of inflammation in the body . We can actually measure this by a measuring C reactive protein. Statins work on all of these issues.
Yes, statin drugs reduce LDL or "bad" cholesterol BUT they also reduce inflammation. Moreover, if there are any plaques of cholesterol (clumps that attach to the lining of the vessel), statins can help reduce those. When the plaques rupture (break open) they form blood clots. If the blood clot breaks off and travels to the heart, you have a heart attack. If it travels to the brain, a stroke. Stains stabalize plaques and decrease the risk this will happen. Even people with good numbers can have plaques.
NO other drugs, not fish oil, not niacin, not fibrates (gemfibrozil or fenofibrate) have been shown to reduce the risk of an event. They can, and do lower your numbers, but do NOT reduce risk. We now treat with statins to lower risk. Statins are classified by how strong they are, or the intensity. There are several factors to consider, but a diabetic should be on atleast a moderate potency (there are high potency) statin to reduce the risk of an event.
I hear people speculate that doctor's, pharmacists and insurance companies push these drugs based on studies done by big pharma. Big pharma does make two fish oil products, Lovaza and Vascepa and a Niacin product called Niaspan. You don't see commercials for these, because there is not 1 Study that shows that they reduce cardiovascular events. Fish oil and fibrates can decrease trigycerides which if high, can lead to pancreatitis. Fish oil has some blood thiing properties and has some anti-inflammatory effects, but still no data to show it reduces stroke or heart attack. Based on the OTC product you purchase it would take 12 to 16 caps a day to see the trigyceride lowering effect.
This is just the tip of the iceberg. The decision to take any medication does, of course, always rest with the individual.
I think it is awesome that your pharmacist cared enough to reach out.
Stain use in patients with diabetes is supported by several Clinical guidelines, The American Diabetes Association, The American Association of Clinical Endocrinologists, and the American Heart Association.
The change from treating to see a good number to treating to risk is relatively new, from 2013 and it is a lot to wrap your head around since it really is not intuitive.
I hope at the very least, that this will get people talking with their physicians.
I wish you continued good health!
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