Statins — the best-selling class of cholesterol-fighting drugs — should be considered as standard therapy for all diabetics, apart from children and pregnant women, results saw a 10% drop in death and a 21% drop in strokes and heart attacks.
A group of British and Australian investigators said the largest study of its kind, involving a pooled analysis of clinical trials involving nearly 19,000 patients with diabetes, found there was a clear benefit in taking statins.
For the study, the researchers conducted a meta-analysis of 18,686 people with diabetes and 71,370 without diabetes who took part in 14 randomized trials that examined the use of statins to reduce levels of low-density lipoprotein (LDL), or "bad" cholesterol. During a mean follow-up of 4.3 years, 3,247 of the people with diabetes experienced vascular events. Among people with diabetes, there was a 9 percent proportional reduction in all-cause death per mmol/L reduction in LDL cholesterol, which was similar to the 13 percent reduction noted in people without diabetes.
The study authors said they found a significant 20 percent proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol in people with diabetes, a decline similar to that seen in people without diabetes.
After five years, 42 fewer people with diabetes had major vascular events, such as heart attacks and strokes, for every 1,000 allocated statin therapy.
The findings are reassuring, particularly in the light of two other recent studies that found no statistically definitive benefit of statins in patients with diabetes. Diabetics are known to be at increased risk of cardiovascular disease.
Colin Baigent of the Clinical Trial Service Unit in Oxford, England, and one of the authors of the research published in the Lancet medical journal, said the latest data cleared up the uncertainty and "statins are clearly effective for a wide range of people with diabetes, irrespective of their absolute risk and irrespective of whether they have type 1 or type 2 (diabetes) or whether they are male or female."
"Generic statins are highly cost-effective, right down to an annual risk of about 1 percent per annum of a major vascular event, so it makes sense for statins to be used widely in most people with diabetes."
Many diabetics already receive a statin because they are deemed at relatively high risk. Baigent said the latest research should encourage doctors to use them more widely still.
"I think individual doctors will be influenced by this and, hopefully, also the guidelines bodies will consider it when they update their guidelines in due course," he said.
Bernard Cheung of the University of Birmingham, England, writing in a commentary in the Lancet, said the latest findings were reassuring but statins were not a panacea and doctors also needed to stress the important of lifestyle changes, such as quitting smoking, healthy diet and regular exercise.
"Most people with diabetes should now be considered for statin therapy, unless their risk is low (e.g., as in children) or statin therapy has been shown to be unsuitable for them (e.g., as in pregnancy)," they concluded.
Lancet, Jan, 2008
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