No matter how old diabetes patients are, whether or not they have cardiovascular disease, irrespective of whether they are male or female, statin therapy reduces the risk of major vascular events, such as heart attack, stroke, or coronary revascularization (the need for an operation to bypass or unblock the coronary arteries). This is according to an Article in The Lancet, this week's issue.

Estimates place the number of people globally with diabetes mellitus at 170 million - a figure which is set to more than double within the next 22 years. Since both Diabetes Types 1 and 2 are linked to a raised risk of cardiovascular disease it is a public-health priority to identify treatments for the prevention of major vascular events.

Previous studies* have demonstrated that statins are effective in preventing major vascular events in diabetes patients. However, the size of any benefits on major coronary events, stroke or coronary revascularization is unclear. A coronary event is, for example, a heart attack or death from coronary heart disease. In addition, questions remain about whether statin therapy is as effective in diabetes patients as in those without diabetes.

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 people with diabetes as well as 71,370 without diabetes from a total of 14 randomized trials. They wanted to see what the effects of statin therapy were in lowering LDL cholesterol.

There were 3,247 vascular events among the people with diabetes during a mean follow-up period of 4.3 years. There was a 9% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol among the diabetes patients - similar to a 13% reduction among the people without diabetes, the researchers found. There was a statistically significant one-fifth proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol in participants with diabetes - a similar figure to that found among the participants without diabetes.

The researchers explain that this relative-risk decrease was similar irrespective of vascular disease history, age, sex, and other baseline factors. After 5 years, 42 fewer diabetes patients per 1,000 allocated statin therapy had vascular events.

"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," the authors wrote.

They concluded that most people with diabetes should now be considered for statin therapy, unless, as is usually the case in children, their risk is low, or statin therapy has been shown to be unsuitable, as in pregnancy.

Accompanying Comment

Professor Bernard Cheung, University of Birmingham, UK, cites statins as among the most notable triumphs of modern medicine. "Apart from drug treatment, one must not forget the importance of lifestyle changes, such as cessation of smoking, healthy diet, and regular exercise," he adds.

* The authors have previously reported the results of a collaborative meta-analysis of 14 randomized trials of statin therapy (the Cholesterol Treatment Trialists [CTT] Collaboration). The results showed that lowering LDL cholesterol by 1 mmol/L reduces the risk of major vascular events by about a fifth in a wide range of high-risk participants, largely irrespective of baseline lipid profile or other presenting characteristics, including diabetes.

"Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomized trials of Statins"
Cholesterol Treatment Trialists' (CTT) Collaborators
The Lancet Page 117 Volume 371 • Number 9607 • January 12-18, 2008

Comment
"Statins for people with diabetes"
B M Y Cheung
The Lancet Page 94 Volume 371 • Number 9607 • January 12-18, 2008
thelancet



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