Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: metaanalysis of randomised controlled trials

Abstract

Objective To evaluate the clinical benefit of lipid lowering drug treatment in patients with and without diabetes mellitus, for primary and secondary prevention. Design Systematic review and meta-analysis. Data sources Cochrane, Medline, Embase, and reference lists up to April 2004. Study selection Randomised, placebo controlled, double blind trials with a follow-up of at least three years that evaluated lipid lowering drug treatment in patients with and without diabetes mellitus. Data extraction Two independent reviewers extracted data. The primary outcome was major coronary events defined as coronary heart disease death, non-fatal myocardial infarction, or myocardial revascularisation procedures. Results Twelve studies were included. Lipid lowering drug treatment was found to be at least as effective in diabetic patients as in non-diabetic patients. In primary prevention, the risk reduction for major coronary events was 21% (95% confidence interval 11% to 30%; P < 0.0001) in diabetic patients and 23% (12% to 33%; P = 0.0003) in non-diabetic patients. In secondary prevention, the corresponding risk reductions were 21% (10% to 31%; P = 0.0005) and 23% (19% to 26%; P ≤ 0.00001). However, the absolute risk difference was three times higher in secondary prevention. When results were adjusted for baseline risk, diabetic patients benefited more in both primary and secondary prevention. Blood lipids were reduced to a similar degree in both groups. Conclusions The evidence that lipid lowering drug treatment (especially statins) significantly reduce cardiovascular risk in diabetic and non-diabetic patients is strong and suggests that diabetic patients benefit more, in both primary and secondary prevention. Future research should define the threshold for treatment of these patients and the desired target lipid concentrations, especially for primary prevention.

Cholesterol, diabetes and major cardiovascular diseases in the Asia-Pacific region

“…The continuous nature of the associations, as clearly demonstrated in these analyses, supports a paradigm whereby cholesterol-lowering strategies should not be primarily driven by arbitrary threshold levels of cholesterol, but rather by the absolute risk of atherothrombotic vascular events, which is generally high among people with diabetes. Our findings are consistent with the results of clinical trials [20][21][22][23][24] and two recent metaanalyses [25,26] that suggest cholesterol lowering is associated with similar relative reductions in risk of cardiovascular outcomes among people with and without diabetes, in the context of both primary and secondary prevention. While the effects of modifying HDL-cholesterol and triacylglycerol in so-called diabetes dyslipidaemia remain uncertain [27], a continuing emphasis on total and LDLcholesterol levels in managing risk among people with diabetes remains justified.…”

Statin adherence and the risk of major coronary events in patients with diabetes: a nested case–control study

“…The risk of myocardial infarction in diabetic patients without prior CHD is similar to the risk in non-diabetic patients with CHD [9,10].The most recent European guideline recommended that statin therapy should be initiated in all patients with diabetes and overt CVD, and in the absence of CVD, it should be considered for all type 1 patients aged over 40 years and for all adult patients with type 2 diabetes whose total cholesterol is greater than 3.5 mmol L -1 [11].These recommendations are mainly based on subgroup analyses (and meta-analyses [12,13]) of randomized controlled trials (RCTs) [4,6,8]. Few studies have been performed specifically in diabetic patients [14,15].…”

Type 2 diabetes patients: profiles, treatment and daily practice

“…Primary and secondary prevention trials, and diabetic and non-diabetic populations, were compared. 11 In the primary prevention trials, people with diabetes had a higher major coronary event rate than people without diabetes at four and a half years' follow-up, as would be expected. However, despite optimal lipid-lowering treatment, people with diabetes still had a significantly higher rate of events as compared to treated people without diabetes.…”