Statins Benefit Diabetics, Regardless of Cholesterol Levels

Journal Watch. 2003;2(7) 


In the randomized, placebo-controlled, U.K. Heart Protection Study, simvastatin therapy (40 mg daily) reduced morbidity and mortality among 20,000 patients with total cholesterol levels of at least 135 mg/dL (3.5 mmol/L) and with coronary disease, other arterial disease, hypertension, or diabetes (Journal Watch Jul 30 2002). Now, the researchers report results from the trial's subgroup of nearly 6000 diabetic patients, most of whom had type 2 diabetes. At baseline, mean total cholesterol level was 220 mg/dL (5.7 mmol/L), and mean LDL cholesterol level was 124 mg/dL (3.2 mmol/L).

The rate of major vascular events was 25% in the placebo group and 20% in the simvastatin group -- a significant 22% difference. Even among participants who had pretreatment LDL cholesterol levels lower than 116 mg/dL (3.0 mmol/L) and without diagnosed arterial disease at study entry, the vascular event rate was significantly lower in the simvastatin group (8% vs. 11%). Among participants who experienced first major vascular events after randomization, subsequent events were significantly less common in the simvastatin group.

These results show that simvastatin therapy leads to significant risk reductions for vascular events in type 2 diabetic patients, even if they don't have diagnosed coronary disease or high cholesterol levels. The authors estimate that 5 years of treatment would prevent about 45 major vascular events per 1000 patients and suggest that statins should be offered to high-risk diabetic patients regardless of their cholesterol levels. An editorialist suggests that this conclusion might even apply to all type 2 diabetic patients.

-- Sir Brian Jarman, PhD, FRCP, FRCGP, FFPHM, FMedSci

Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: A randomised placebo-controlled trial. Lancet 2003 Jun 14; 361:2005-16.

Lindholm LH. Major benefits from cholesterol-lowering in patients with diabetes. Lancet 2003 Jun 14; 361:2000-1.

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