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Aggressive Lipid Lowering Is Especially Helpful in Diabetics
For secondary prevention, absolute risk was reduced significantly more in diabetic patients than in nondiabetic patients.
Lipid-lowering drugs (statins and fibrates) avert both primary and secondary adverse cardiovascular events in many patients. In this meta-analysis, researchers compared the effects of these drugs in patients with or without diabetes. Twelve randomized trials, in which lipid-lowering drugs were compared with placebo, were evaluated. An inclusion criterion was that both arms include diabetic and nondiabetic participants.
The magnitude of change in lipid levels was similar in the diabetic and nondiabetic groups. For both primary and secondary prevention, relative risks for major adverse coronary events were reduced similarly, by 21% in diabetic patients and by 23% in nondiabetic patients. For secondary prevention, absolute risk was reduced significantly more in diabetic patients than in nondiabetic patients (7% vs. 5%). In analyses adjusted for baseline risk, secondary prevention of coronary death, nonfatal myocardial infarction, revascularization, and stroke was significantly better among diabetic patients than among nondiabetic patients.
Comment: This analysis suggests that diabetic patients might benefit from lipid lowering that is even more aggressive than that used for other patients, but further research is required to determine the proper treatment threshold and target level. In an accompanying editorial, the writer supports intensive statin use in diabetic patients but reminds us that 70% of adverse cardiovascular events will still occur. At the time of publication, the full text of the original article was available free of charge.
— Keith I. Marton, MD
Published in Journal Watch General Medicine June 16, 2006
Citation(s):
Costa J et al. Efficacy of lipid-lowering drug treatment for diabetic and non-diabetic patients: Meta-analysis of randomised controlled trials. BMJ 2006 May 13; 332:1115-8.
- Original article (Subscription may be required)
- Medline abstract (Free)
Reckless JPD. Diabetes and lipid lowering: Where are we? We’re now sure that statins cut cardiovascular risks in type 2 diabetes. BMJ 2006 May 13; 332:1103-4.
- Original article (Subscription may be required)
- Medline abstract (Free)