Routine use of statins in all type 2 diabetes patients is a step too far
Routine use of statins in all patients with type 2 diabetes may not be necessary, suggests the author of an editorial published in The
Lancet (2004;364:641).
Commenting on the CARDS trial (collaborative atorvastatin diabetes study),
Abhimanyu Garg, of the University of Texas Southwestern Medical Centre,
says that the investigators’ conclusion that all patients with
type 2 diabetes should receive statin therapy seems “far-fetched”.
The CARDS trial recruited patients with type 2 diabetes who had a low-density
lipoprotein cholesterol level of below 4.14mmol/L and a cardiovascular
risk factor, such as hypertension. More than half had an LDL level below
3.3mmol/L and a quarter had a level of 2.6mmol/L or lower. Patients were
randomised to either atorvastatin 10mg or placebo for five years.
The CARDS investigators found that atorvastatin 10mg reduced risk of
first cardiovascular events: acute coronary heart disease events were
reduced by 36 per cent, coronary revascularisations by 31 per cent and
rate of stroke by 48 per cent. They also found that atorvastatin reduced
mortality in type 2 diabetes by 27 per cent.
The investigators conclude that
cholesterol level should no longer be used to determine whether or not
patients with type 2 diabetes receive statins (ibid, p685).
However, Dr Garg is not so sure. “While landmark trials like CARDS
increase our confidence in lipid-lowering drug therapy for prevention
of coronary heart disease in patients with type 2 diabetes, it is still
prudent to assess an individual’s risk-benefit ratio before recommending
long-term statin therapy,” he says.
He also points out that other trials of statins in patients with diabetes
have failed to show similar reductions in coronary heart disease risk.
Data from the CARDS
trial were first presented at the American Diabetes
Association annual meeting in Florida earlier this year (PJ, 12 June,
p729). |
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