A reader writes: I've read that because I have type 2 diabetes, I should take a statin medication even though my cholesterol levels are normal. Is this true? Here's the answer from Dr. Christopher D. Saudek and colleagues at the Johns Hopkins University School of Medicine.

Dr. Saudek: That depends on what you mean by "normal" and on your own individual risk. Type 2 diabetes is itself a major risk factor for coronary heart disease (CHD). In fact, recent research has shown that people with type 2 diabetes without a history of CHD have as much risk for heart attack as people without diabetes but with CHD. Reducing this risk is perhaps the most important thing you can do to improve your longevity.

If your LDL cholesterol is not at the target of less than 100 mg/dL (or less than 70 mg/dL if you have had a heart attack), the American Diabetes Association recommends treat- ment with a statin drug. Several large studies have shown a significant reduction in heart attacks and strokes in people with diabetes who took statin drugs to lower their LDL cholesterol. Six statins are available: atorvastatin (Lipitor); fluvastatin (Lescol); lovastatin (Mevacor); pravastatin (Pravachol); rosuvastatin (Crestor); and simvastatin (Zocor).

The American Diabetes Association recommends niacin (nicotinic acid) for people with diabetes who have low levels of HDL cholesterol (less than 40 mg/dL in men or 50 mg/dL in women) and fibrate drugs (Lopid, Lofibra, Tricor) for elevated levels of triglycerides (more than 200 mg/dL). Since niacin can increase blood glucose levels, your diabetes doctor will monitor you while you are using the drug.

Any drug has potential downsides and for statins, the most common side effects are muscle aches, diarrhea, and upset stomach. Be sure to discuss with your doctor whether statin therapy is the best treatment decision for you.