The Pharmaceutical Journal
Vol 270 No 7253 p814
14 June 2003

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The Lancet (www.thelancet.com)

Give statins to diabetes heart risk patients

All people with diabetes who are at risk for heart attacks or strokes should be offered statin therapy, regardless of their initial cholesterol levels, researchers say after the latest analysis of the Heart Protection Study.

Of the approximately 20,000 participants in the study, 5,963 were known to have diabetes on entry. In the trial, they were randomised to receive 40mg simvastatin daily or placebo. Over the five-year treament period, there were reductions of 27 per cent (95 per cent confidence interval 15–38, P<0.0001) in major coronary events, 24 per cent (CI 6–39, P=0.01) in strokes and 17 per cent (CI 3–30, P=0.02) in revascularisations for those in the active treatment group compared with placebo. Overall, only about 20 per cent of those patients with diabetes who were receiving simvastatin, compared with about 25 per cent on placebo, had a first major vascular event during the five-year follow-up. The proportional reductions did not appear to be influenced by pretreatment lipid levels (or various ratios of these measures).

The authors of the study say that decsions about whether to initiate statin therapy should now be based on individuals' cardiovascular risk rather than lipid levels (Lancet 2003;361:2005).

Commenting on the findings, Lars Lindholm of Umeå University Hospital, Sweden, says that simvastatin has recently come off patent and fallen in price. "One could go a step further and ask whether all patients with type 2 diabetes should be given a statin, regardless of their cholesterol value." (Ibid, p2000.)