From the Guidelines
You can generally add a statin to your medication regimen of Jardiance and Lantus, even with cirrhosis and diabetes at age 72, as the benefits of statins for cardiovascular protection often outweigh the risks, especially in patients with compensated cirrhosis, as indicated by the most recent guidelines 1. When considering the addition of a statin, it's essential to note that statin therapy is safe in adults with type 2 diabetes and compensated cirrhosis from nonalcoholic fatty liver disease and should be initiated or continued for cardiovascular risk reduction as clinically indicated 1. The choice of statin and dosage should be individualized, considering the patient's cardiovascular risk factors and potential drug interactions with their current medications, including Jardiance and Lantus. Some key points to consider when adding a statin include:
- Starting with a lower dose, such as 10-20mg daily, and monitoring liver function tests and muscle symptoms closely 1.
- Regular blood tests to monitor liver enzymes (every 3-6 months initially) are crucial given the patient's cirrhosis.
- The patient should be aware of potential side effects, such as muscle pain, weakness, or dark urine, and contact their doctor immediately if these symptoms occur. Given the patient's age and diabetes status, they are at increased risk for cardiovascular disease, and statin therapy may be beneficial for primary prevention, as supported by recent guidelines 1. However, the decision to add a statin should be made in consultation with the patient's healthcare provider, taking into account their complete medical history and individual risk factors.
From the Research
Statin Use in Patients with Cirrhosis and Diabetes
- The use of statins in patients with cirrhosis has been limited due to concerns about hepatotoxicity, but recent evidence suggests that statins are safe and effective in patients with compensated cirrhosis 2, 3.
- Statins have pleiotropic properties that are independent of their effect on cholesterol levels, such as improving endothelial dysfunction, antioxidant, antifibrotic, anti-inflammatory, antiproliferative, antiangiogenic, proapoptotic, or immunomodulation properties 2.
- In patients with decompensated cirrhosis, statins should be prescribed with extreme caution at low doses, and with frequent monitoring of creatinine phosphokinase levels to detect adverse events in a timely fashion 2, 3.
- The addition of statins to the standard treatment in patients with cirrhosis has been shown to be safe and effective, with a reduced risk of hepatic decompensation, hepatocellular carcinoma development, and death 3.
Management of Diabetes in Patients with Cirrhosis
- Type 2 diabetes mellitus is a frequent comorbidity in patients with cirrhosis, and its management is complex due to the requirement for accurate adaptation according to the level of liver function impairment 4, 5.
- The diagnosis of diabetes may be missed if based on A1C in patients with cirrhosis and impaired liver function, and clinicians must be aware of the high risk of hypoglycemia, especially in decompensated cirrhosis 5.
- Management of diabetes in patients with cirrhosis should be conditioned by whether the patient has either compensated or decompensated cirrhosis, and clinicians should become familiar with the safety and efficacy of diabetes medications for patients with advanced fibrosis and compensated cirrhosis 5.
Current Medications and Potential Addition of Statin
- The patient is currently taking Jardiance (empagliflozin) and Lantus, which are effective and generally well-tolerated medications for the treatment of type 2 diabetes 6.
- The potential addition of a statin to the patient's medication regimen should be considered in the context of their cirrhosis and diabetes, and the benefits and risks of statin therapy should be carefully weighed 2, 3.