Letter: Efficacy of Moderate Intensity Statins in the Treatment of Dyslipidemia in Korean Patients with Type 2 Diabetes Mellitus (Diabetes Metab J 2017;41:23-30)

Corresponding author: Jae-Han Jeon http://orcid.org/0000-0002-9217-968X Department of Internal Medicine, Kyungpook National University School of Medicine, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea E-mail: ggoloo@hanmail.net According to the recently released Diabetes Fact Sheet in Korea 2016, the control rate of dyslipidemia in people with diabetes is still under 50%. Whether it is the result of neglected diagnosis or treatment of dyslipidemia, miss-selection of adequate statin dose by doctors, or whether it is a consequence of patients’ poor adherence to statin therapy is still unknown. However, on the basis that reducing low density lipoprotein cholesterol (LDL-C) levels in an aggressive manner is beneficial in the primary prevention of cardiovascular disease (CVD), a recent guideline released by American College of Cardiology/ American Heart Association in 2013 recommends that people with diabetes aged between 40 and 75 should be prescribed with at least moderate intensity statin, and that those with estimated 10-year atherosclerotic CVD risk ≥7.5% should be considered for high intensity statins [1]. Given the high comorbidities accompanying diabetes, it is highly likely that the majority will require high intensity statins according to this guideline. In the recent few years, however, disputes on whether this guideline can be applied to Koreans as its current form have risen in light of previous reports demonstrating the greater efficacy of low to moderate intensity statins in Koreans compared with Caucasians. In one of these studies, even 2 months of administration of low intensity statins such as 20 mg of lovastatin and 20 mg of pravastatin was sufficient to induce more than 30% reduction of LDL-C from baseline in 60% of patients; thus, was as potent as “moderate intensity” statins [2]. Furthermore, high intensity statins failed to show superiority over moderate/low intensity statins in terms of preventing major adverse cardiac events in Korean patients that previously experienced myocardial infarction [3]. These studies, however, encompassed patients without diabetes. On the other hands, an article entitled “Efficacy of moderate intensity statins in the treatment of dyslipidemia in Korean patients with type 2 diabetes mellitus” released in this issue imposes the importance of considering ethnic differences in the treatment of dyslipidemia in patients with diabetes [4]. The authors showed that 6 months of treatment with moderate intensity statins elicited an average of 47.4% LDL-C reduction from baselines in their retrospective cohort. As their baseline LDL-C was only 135 mg/dL, 92% of patients achieved LDL-C levels below 100 mg/dL. Notably, 5 mg of rosuvastatin was capable of inducing 51.6% reduction of LDL-C, which is nearly as effective as high intensity statin in Caucasians. As statin-induced diabetes and myopathy are of major issues, safety issues were examined; the result showed that moderate intensity statins do not impact glycemic profiles, and musculoskeletal symptoms were absent in these patients. It would have been much more valuable if the authors compared the efficacies among low, moderate, and high intensity statins in this diabetes cohort. Nevertheless, it is still of great clinical significance because it provides a rationale that early, modest statin treatment can normalize LDL-C in over 90% of patients with Letter