Statins Urged for Diabetic Patients

People with diabetes require intensive statin therapy even if their levels of low-density lipoprotein (LDL) cholesterol is within the normal range. The American Diabetes Association recommendations state that diabetics who are older than 40 years of age whose total cholesterol exceeds 3.5 mmol/L (135 mg/dL) should be placed on statin therapy to achieve a 30% to 40% reduction in LDL level, regardless of their baseline LDL level and even if they do not have overt cardiovascular disease.

In the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction (PROVE-IT) study, treatment with atorvastatin 80 mg/day lowered LDL cholesterol levels to a median of 1.6 mmol/L (62 mg/dL) in diabetics and nondiabetics alike, compared to 2.5 mmol/L (97 mg/dL) with the standard pravastatin40-mg regimen.
Among patients taking atorvastatin, the hazard ratio for a cardiovascular event was 16% less than it was for patients on pravastatin after the mean follow-up period of 24 months, a significant difference (Cannon C. et al. N Engl J Med 2004;350:1495-1504).

Dr. Betteridge urged physicians to follow the recommendations in the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults released by the U.S. National Cholesterol Education Program. This panel established a goal LDL cholesterol level of <1.8 mmol/L (<69 mg/dL) for patients with diabetes and cardiovascular disease, regardless of their baseline LDL cholesterol level.

"The message is, the lower the LDL the better, particularly in our patients with diabetes," he said. Raising the high-density lipoprotein (HDL) cholesterol level also seems to help reduce cardiovascular risk in diabetics, Dr. Betteridge said.

Further analysis in this study showed that diabetic patients benefited as much as nondiabetics from the drug intervention, Dr. Betteridge said.

75th Annual Congress of the European Atherosclerosis Society. [Presentation title: Targeted Treatment of Diabetic Dyslipidemia: Background and Current Approaches.]

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DID YOU KNOW:
Americans with metabolic syndrome account for $4 of every $10 spent on prescription drugs for adults, according to a study. The report by Medco Health Solutions, shows that adult use of medication for the syndrome jumped 36 percent between 2002 and 2004. According to various U.S. estimates, at least one in four adults and roughly one in eight children have metabolic syndrome, with overeating and inactivity being key causes.