Lipid-lowering agents, particularly statins, significantly reduce cardiovascular risk in people with diabetes, to the extent that these patients may benefit from the drugs even more than nondiabetics do, according to Dr. Joào Costa of the University of Lisbon and associates.
Dr. Costa and associates reviewed 12 large studies that addressed lipid-lowering treatments and also included diabetic patients in all treatment arms.
Their metaanalysis showed that lipid-lowering drugs were equally effective in diabetic and nondiabetic patients in primary prevention. The use of statins or gemfibrozil reduced the risk of a first major coronary event by 21% in diabetic patients and by 23% in nondiabetics.
The results were similar for secondary prevention, except that diabetic patients benefited more than did nondiabetics. The use of statins or gemfibrozil reduced the risk of coronary artery disease death, nonfatal MI, revascularization procedures, and stroke to a greater degree in diabetic patients than it did in nondiabetics.
The magnitude of change in blood lipids for diabetic patients was comparable to that for nondiabetics. “Most trials showed a decrease of 15%–20% in total cholesterol and increases of 5%–7.5% in HDL cholesterol,” the investigators said (BMJ 2006 April 3 [Epub doi:10.1136/bmj.38793.468449.AE]).
“Our metaanalysis clearly confirms that reduction of LDL cholesterol concentrations results in an important decrease in major coronary events in diabetic patients and shows similar relative risk reductions and odds ratios for … diabetic and nondiabetic patients … in primary and secondary prevention. However, the absolute risk difference was three times higher in secondary prevention, reflecting the higher baseline cardiovascular risk of [diabetic] patients,” they noted.