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ANDREW TONKIN, MD, FRACP FOR THE LIPID STUDY GROUPOBJECTIVE -Diabetes, a major health problem worldwide, increases the risk of cardiovascular disease and its associated mortality. Evidence of the overall benefits of lipid modification in this area is needed. RESEARCH DESIGN AND METHODS -The Long-TermIntervention with Pravastatin in Ischemic Disease (LIPID) trial showed that cholesterol-lowering treatment with pravastatin reduced mortality and coronary heart disease (CHD) events in 9,014 patients aged 31-75 years with CHD and total cholesterol 4.0 -7.0 mmol/l. We measured the effects of pravastatin therapy, 40 mg/day over 6.0 years, on the risk of CHD death or nonfatal myocardial infarction and other cardiovascular outcomes in 1,077 LIPID patients with diabetes and 940 patients with impaired fasting glucose (IFG).RESULTS -In patients allocated to placebo, the risk of a major CHD event was 61% higher in patients with diabetes and 23% higher in the IFG group than in patients with normal fasting glucose, and the risk of any cardiovascular event was 37% higher in the diabetic group and 19% higher in the IFG group. Pravastatin therapy reduced the risk of a major CHD event overall from 15.9 to 12.3% (relative risk reduction [RRR] 24%, P Ͻ 0.001) and from 23.4 to 19.6% in the diabetic group (19%, P ϭ 0.11); in the diabetic group, the reduction was not significantly different from the reductions in the other groups. Pravastatin reduced the risk of any cardiovascular event from 52.7 to 45.2% (21%, P Ͻ 0.008) in patients with diabetes and from 45.7 to 37.1% (26%, P ϭ 0.003) in the IFG group. Pravastatin reduced the risk of stroke from 9.9 to 6.3% in the diabetic group (RRR 39%, CI 7-61%, P ϭ 0.02) and from 5.4 to 3.4% in the IFG group (RRR 42%, CI Ϫ9 to 69%, P ϭ 0.09). Pravastatin did not reduce the incidence of diabetes. Over 6 years, pravastatin therapy prevented one major CHD event (CHD death or nonfatal myocardial infarction) in 23 patients with IFG and 18 patients with diabetes. A meta-analysis of other major trials confirmed the high absolute risks of diabetes and IFG and the absolute benefits of statin therapy in these patients.CONCLUSIONS -Cholesterol-lowering treatment with pravastatin therapy prevents cardiovascular events, including stroke, in patients with diabetes or IFG and established CHD. Diabetes Care 26:2713-2721, 2003D iabetes is the most common endocrine disorder worldwide, with an estimated prevalence of 140 million adults in 1997 (1). As many adults have an elevated fasting glucose level, or impaired fasting glucose (IFG) (2,3), which is not a clinical entity but a risk factor for futuredevelopmentofdiabetesandmacrovascular disease. Cardiovascular disease complications are now the leading causes of morbidity and mortality in people with diabetes (4). Diabetes increases the risk of developing cardiovascular disease up to fivefold, and as many as 80% of patients with type 2 diabetes die from cardiovascular complications. This high risk is not completely explained by traditional risk factors (5,6). IFG i...

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There is a lack of high quality evidence for the efficacy of progestin in CAH or EC. The available evidence however suggests that treatment with oral or intrauterine progestin is similarly effective. The risk of progression during treatment is small but longer follow-up is required. Evidence from prospective controlled clinical trials is warranted to establish how the efficacy of progestin for the treatment of CAH and EC can be improved further.