Statin choice in type 2 diabetes with high LDL and CAC
I am a 52-year-old female (Indian) and have been diagnosed with type 2 diabetes (since last year) and am on the maximum dose of metformin, controlling A1C to 6.5 or so (from 14.1 at the time of diagnosis). Recently and suddenly, my cholesterol has gone up to LDL 197 (HDL 59); also ApoB 156, CRP 4.5. Did CAC CT and numbers put me at the 98th percentile. However, CIMT shows that my cardiovascular age is less than my chronological age. My PCP and Endo want me on statins. Still, there’s a difference in opinion- after some back & forth and push from my side for a prescription that favors South Asian genes, my endo says pitavastatin is preferable to rosuvastatin (or Lipitor), specifically for South Asian genes as well as having diabetes. My PCP says the American Heart Association does not list pitavastatin as a preferred statin, and she hasn’t seen anyone in her medical circle prescribe it, and is reluctant to prescribe it. I did some research and found some comparisons of Pitavastatin that support what my endo says. One such study link: Systematic Review on Efficacy, Effectiveness, and Safety of Pitavastatin in Dyslipidemia in Asia Would you have any opinions on statins for the comorbidity of diabetes + high cholesterol + high CAC CT Agatston score?
Both are correct from their own “lens” ! Pitavastatin has less adverse effects on blood sugar (so less worsening of sugars/ prediabetes etc) but is considered a MODERATE intensity statin (lower LDL lowering). Rosuvastatin has somewhat higher effects on blood sugar worsening but is considered a HIGH INTENSITY statin meaning a strongly effect on LDL. In your high-risk situation it is imperative to lower LDL significantly : ROSUVASTATIN is the best way to go (and accept the slightly higher adverse effect on sugar) Pitavastatin is unlikely to get you to target on your LDL