World Alert: Call for More Aggressive Treatment of Cardiovascular Risk in Type 2 Diabetes Patients*

Results of the Heart Protection Study provide strong evidence for aggressively managing cardiovascular risk in type 2 diabetic patients.

As a result of these findings, and in light of the dramatic rise in type 2 diabetes in developed countries, a diabetes expert is calling for global action.

Physicians treating patients with diabetes must reduce overall heart disease risk by tackling the major cardiovascular disease risk factors using lifestyle and drug therapy alongside the strict control of hyperglycemia, according to Professor John Betteridge from Middlesex Hospital in London, United Kingdom. Strict control has been linked to significant reductions in microvascular disease in trials such as the UK Prospective Diabetes Study (UKPDS).

The role of statins in the prevention of cardiovascular complications in type 2 diabetic patients is highlighted in the Heart Protection Study. For this trial, 20,536 individuals from within a variety of disease categories and risk factors were recruited in 69 hospitals from 1994 to 1997. They were randomly assigned to treatment with 40 mg of simvastatin daily or a placebo. Within the treatment and control groups, half of patients took antioxidant vitamins (600 mg vitamin E, 250 mg vitamin C, and 20 mg beta-carotene daily) and half took a placebo.

The Heart Prevention Study demonstrated that patients with type 2 diabetes benefit from lipid lowering treatment with simvastatin, even if they had normal cholesterol and no other cardiovascular risk factors. Their risk of a cardiovascular event, defined as fatal or non-fatal myocardial infarction (MI) or stroke, was reduced by about 25 percent for every 1 mmol/L decrease in total cholesterol levels.

These results are particularly important given that those with type 2 diabetes are more likely to have a serious cardiovascular event than non-diabetics with the same cholesterol level. Post-myocardial infarction mortality rates are also higher in diabetic than non-diabetic patients.

"The evidence of the Heart Protection Study was a strong addition to the evidence base supporting aggressive lipid lowering in patients with diabetes and provided a convincing argument that the status of diabetes as a risk factor for cardiovascular disease should be increased," said Dr. Betteridge.

Dr. Betteridge backed the change to the recommendations of the United States National Cholesterol Education Program's Third Adult Treatment Panel (NCEP ATP III) that ranks diabetes as a cardiovascular risk factor, alongside all the traditional risk factors, when deciding whether to initiate lipid lowering therapy.

He also called on those drafting new editions of European guidelines, including the European Society of Cardiology, to follow suit as swiftly as possible so that they reflect the new evidence from the Heart Protection Study. Currently, these guidelines are based on Framingham Heart Study data and probably underestimate the risk of cardiovascular disease in people with diabetes, he said.