[PHNUTR-L] Most people with diabetes should be considered for statin therapy

[Kathrynne Holden]

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Public release date: 10-Jan-2008
http://www.eurekalert.org/pub_releases/2008-01/l-mpw010908.php

Contact: Medical Research Council
press.office at headoffice.mrc.ac.uk
020-767-05139
Lancet

Most people with diabetes should be considered for statin therapy

Statin therapy reduces the risk of major vascular events* in a wide 
range of individuals with diabetes, irrespective of whether they already 
have cardiovascular disease, and regardless of age, sex, and other 
clinical characteristics. As such, most people with diabetes should now 
be considered for statin therapy, according to an Article in this week’s 
issue of The Lancet.

At least 170 million people worldwide are estimated to have diabetes 
mellitus, and this number is predicted to more than double by 2030. 
Since both types of diabetes are associated with increased risk of 
cardiovascular disease the identification of treatments for the 
prevention of major vascular events is a public-health priority. 
Although previous studies** have shown that statin therapy is effective 
for the prevention of major vascular events in patients with diabetes, 
there has been uncertainty about the size of any benefits on major 
coronary events (ie, heart attack or death from coronary heart disease), 
on stroke, and on coronary revascularisation (the need for an operation 
to bypass or unblock the coronary arteries). Moreover, there are 
unanswered questions about whether statin therapy is as effective in 
patients with diabetes as in those without diabetes, and whether statins 
are beneficial in people with diabetes who do not have a history of 
vascular disease.

To answer these questions, the Cholesterol Treatment Trialists’ (CTT) 
Collaborators (Clinical Trial Service Unit and Epidemiological Studies 
Unit, Oxford, UK and National Health and Medical Research Council 
Clinical Trial Centre, Sydney, Australia) did a meta-analysis of 18 686 
individuals with diabetes and a further 71 370 without diabetes in 14 
randomised trials to explore the effects of lowering LDL cholesterol 
with statin therapy.

During a mean follow-up of 4.3 years, there were 3247 vascular events in 
people with diabetes. The researchers found a 9% proportional reduction 
in all-cause mortality per mmol/L reduction in LDL cholesterol in 
participants with diabetes, which was similar to the 13% reduction in 
those without diabetes. There was a significant one-fifth proportional 
reduction in major vascular events per mmol/L reduction in LDL 
cholesterol in people with diabetes, which was similar to the effect 
observed in those without diabetes. The authors note that this 
relative-risk reduction was similar irrespective of previous history of 
vascular disease, age, sex, and other baseline characteristics. After 5 
years, 42 fewer people with diabetes had major vascular events per 1000 
allocated statin therapy.

The authors say: “This meta-analysis shows convincingly that the 
proportional benefits of statin therapy on major vascular events were 
similar in a wide range of individuals with diabetes, including those 
with no previous history of vascular disease, and benefits were similar 
to those observed in people without diabetes.”

They conclude: “Most people with diabetes should now be considered for 
statin therapy, unless their risk is low (eg, as in children) or statin 
therapy has been shown to be unsuitable for them (eg, as in pregnancy.”***

In an accompanying Comment, Professor Bernard Cheung (University of 
Birmingham, UK) says that statins are among the most notable triumphs of 
modern medicine and adds: “Apart from drug treatment, one must not 
forget the importance of lifestyle changes, such as cessation of 
smoking, healthy diet, and regular exercise.”

###

Medical Research Council press office, London, UK. T) 020 7670 5139 or 
out of hours 07818 428 297 press.office at headoffice.mrc.ac.uk

Comment Professor Bernard Cheung, University of Birmingham, UK. T) +44 
(0)121 414 47548 b.cheung at bham.ac.uk
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
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