Statins Reduce Blood Vessel Disease in Diabetes

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Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis, by the Cholesterol Treatment Trialists’ Collaborators. The Lancet 371:117-125, 2008

What is the problem and what is known about it so far?

Diabetes is associated with cholesterol and other blood fat disorders that can lead to blocked blood vessels. Statins are a class of medicine for the treatment of cholesterol problems. Statins are known to reduce the risk of problems caused by blocked blood vessels, such as heart attacks, strokes, or the need for procedures to reopen blocked vessels in people with diabetes. However, there is uncertainty about statins’ effects on particular types of blood vessel disease events. Also, little is known about whether such effects depend on the type of diabetes, individual patients’ blood fat levels, or other factors.

Why did researchers do this particular study?

The researchers wanted to learn more about the specific effects of statins in people with diabetes and what might influence them.

Who was studied?

Data was analyzed for a total of 18,686 people with either type 1 or type 2 diabetes from 14 previous studies of statin therapy.

How was the study done?

Researchers performed a meta-analysis (a study that combines and analyzes data from previous studies) of 14 statin therapy studies involving people with diabetes. They examined the effect of statins on heart attacks, death from heart disease, strokes, and the need for procedures to reopen blocked blood vessels around the heart.

What did the researchers find?

For every 18 mg/dl that statins lowered LDL ("bad") cholesterol, there was a 9% drop in death in people with diabetes. There was also a 21% reduction in major events such as heart attacks and strokes. In all diabetic subjects, statins reduced the 5-year chance of having a major blood vessel-related event by about one-fifth for every decline of 18 mg/dl in LDL cholesterol. In addition, there were significant drops in the need for procedures to reopen blocked vessels. These effects were similar among people with diabetes regardless of whether they had a history of blood vessel disease and regardless of any other differences. The reduction in LDL cholesterol that can be expected from usual doses of statins would prevent about one-third of patients from having a major heart attack or related event.

What were the limitations of the study?

Because the data for this study came from people who were selected with varying criteria, the exact benefits of therapy might not apply directly to the general population of people with diabetes. However, because the findings were so consistent for different types of blood vessel-related events and for many different people, the general findings probably apply to most patients with diabetes.

What are the implications of the study?

Statin therapy should be considered for all diabetic patients who are at high risk for problems related to blood vessel disease.

FOR MORE INFORMATION

Diabetes, heart disease, and stroke

Diabetes, cholesterol, and heart disease

Diabetes complications