The Pharmaceutical Journal
Vol 280 No 7485 p40
19 January 2008

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Statins suggested for all patients with diabetes

Statin therapy reduces the risk of major vascular events in a wide range of patients with diabetes, including those with no history of vascular disease, and the benefits are similar to those for people without diabetes, a recently published study reveals (Lancet 2007;371:117).

The researchers say that all people with diabetes should be considered for statin therapy unless their risk of major vascular events is low (for example, type 1 diabetes in children).

Researchers conducted a meta-analysis of 14 trials involving 18,686 individuals with diabetes (mainly type 2) and 71,370 without diabetes.

During a mean follow-up of 4.3 years, there was a 9 per cent proportional reduction in all-cause mortality per mmol/L reduction in low-density lipoprotein cholesterol in participants with diabetes (rate ratio 0.91, 99 per cent confidence interval 0.82–1.01; P=0.02). This was similar to the 13 per cent reduction seen in patients without diabetes (0.87, 0.82–0.92; P<0.0001).

In all diabetic participants, statin therapy reduced the five-year incidence of major vascular events by 21 per cent per mmol/L reduction in LDL cholesterol, say the researchers. There were also reductions seen in myocardial infarction, coronary revascularisation and stroke in diabetic patients.

Although most participants had type 2 diabetes, there was no evidence that the effects of statins on major vascular events in those with type 1 diabetes differed.

The authors say that the effect of statin therapy in those with diabetes was similar irrespective of various risk factors. They add that the benefits seemed to be linearly related to the absolute LDL cholesterol reduction, without any lower threshold, suggesting that guidelines which recommend titration of therapy to achieve a particular target may need to be reviewed.