Should patients with no history of heart disease, an LDL <90 mg/dL, and well-controlled diabetes be given a statin?
—Quoc D. Nguyen, DO, Antioch, Calif.

Many clinicians would say “no”—a not unreasonable answer—but I will say “yes” for the following reasons: (1) Diabetic patients have a poorer prognosis than their nondiabetic counterparts because of the more malignant nature of their vascular disease (even without overtreated symptoms) and should be managed aggressively whenever possible. (2) Current thinking is that the lower the LDL the better, even when the level is already at 90 (J Am Coll Cardiol. 2005;46:1411-1416). (3) Statins have anti-inflammatory actions in addition to their anti-lipid effects, and CAD is increasingly thought to be related to vascular inflammation and thrombosis as well as lipid deposition (J Am Coll Cardiol. 2005;46:1425-1433). Readers who differ are encouraged to write to us with their point of view.
—Peter F. Cohn, MD (114-15)

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