Treating dyslipidemia in patients with type 2 diabetes mellitus without cardiovascular disease appears to result in a clinical benefit equivalent to or greater than that seen with treating non-diabetic cardiovascular disease patients.
Type 2 diabetes is linked to an increased risk of future cardiovascular events, and the risk of a cardiovascular event is as high among patients with diabetes as among non-diabetic patients who have had a cardiovascular event. Therefore, targeted cardiovascular risk reduction strategies may benefit these patients.
Steven A. Grover MD, MPA, with the Centre for the Analysis of Cost-Effective Care at the Montreal General Hospital, Quebec, Canada, and colleagues estimated the number of adults (ages 30 to 74 years) requiring lipid therapy using data from the third National Health and Nutrition Examination Survey and current lipid treatment guidelines.
They then calculated the mean increase in life expectancy that would result from lowering low-density lipoprotein cholesterol levels by 35% and increasing high-density lipoprotein cholesterol levels by 8% based on results from the Scandinavian Simvastatin Survival Study.
The mean number of years of life saved ranged from 3 to 3.4 years for men with diabetes versus 2.4 to 2.7 years for men with cardiovascular disease. In women, the estimated benefits were 1.6 to 2.4 years for those with diabetes versus 1.6 to 2.1 years for those with cardiovascular disease. Furthermore, for patients with diabetes, total population benefits were also substantial (25.4 million person-years of life saved) versus 16.0 million person-years of life saved for those with cardiovascular disease.
"The clinical benefits of treating dyslipidemia in patients with diabetes should be at least equivalent to, if not more substantial than, the benefits observed among those with cardiovascular disease," Dr. Grover and colleagues conclude.
According to the researchers, the analyses suggest "that dyslipidemia in patients with diabetes should be treated for primary prevention with the same intensity recommended for secondary prevention in patients with cardiovascular disease, before the development of cardiovascular disease," and this is consistent with the recent National Cholesterol Education Program guidelines. Am J Med 2003;115:2:122-128
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