From the Guidelines
You can add a statin to your medication regimen of Jardiance and Lantus, even with cirrhosis and diabetes at age 72, as 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. Statins like atorvastatin (Lipitor) or rosuvastatin (Crestor) are often prescribed at lower starting doses (10-20mg daily) for patients with liver disease. However, this decision requires your doctor's evaluation since cirrhosis affects how your liver processes medications. Your liver function tests should be monitored regularly, typically every 3-6 months, to ensure the statin isn't causing additional liver stress.
Key Considerations
- Statins are particularly beneficial for diabetic patients as they reduce cardiovascular risk beyond just lowering cholesterol 1.
- The combination with Jardiance (empagliflozin) and Lantus (insulin glargine) doesn't typically cause problematic interactions, but your doctor should review all your medications to check for specific concerns.
- Despite your metformin intolerance, adding a statin could provide important cardiovascular protection that complements your diabetes management.
Cardiovascular Risk Reduction
- Multiple clinical trials have demonstrated the beneficial effects of statin therapy on ASCVD outcomes in subjects with and without CHD 1.
- Meta-analyses, including data from over 18,000 people with diabetes from 14 randomized trials of statin therapy, demonstrate a 9% proportional reduction in all-cause mortality and 13% reduction in vascular mortality for each 1 mmol/L (39 mg/dL) reduction in LDL cholesterol.
Statin Therapy in Older Adults
- Moderate-intensity statin therapy is recommended in people with diabetes who are >75 years of age, but the risk-benefit profile should be routinely evaluated in this population, with downward titration of dose performed as needed 1.
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 studies suggest that statins are safe and effective in this population, especially in those with compensated cirrhosis 2, 3, 4.
- Statins have pleiotropic properties that can improve endothelial dysfunction, reduce inflammation, and prevent liver-related morbidity and mortality in patients with cirrhosis 2, 3, 4.
- However, patients with decompensated cirrhosis should be prescribed statins with caution and at low doses, with frequent monitoring of creatinine phosphokinase levels to detect adverse events 2, 3.
Considerations for Adding Statin to Current Treatment
- The current treatment regimen includes Jardiance and Lantus, which are used to manage diabetes, but there is no mention of statin use 5, 6.
- Considering the patient's age (72) and comorbidities (cirrhosis and diabetes), adding a statin to the treatment regimen may be beneficial in reducing cardiovascular risk and liver-related complications, but this should be done under close medical supervision 2, 3, 4.
Diabetes Management in Patients with Cirrhosis
- The management of diabetes in patients with cirrhosis is complex and requires careful consideration of the level of liver function impairment 5, 6.
- Early diagnosis and treatment of diabetes are critical in patients with cirrhosis, and clinicians should be aware of the high risk of hypoglycemia, especially in decompensated cirrhosis 5, 6.