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use of HMG CoA reductase inhibitors (statins) in patients with diabetes mellitus

Managagment: - American College of Physicians recommends a statin for patients with diabetes plus one additional risk factor - American Diabetic Association recommends a statin for any patient with diabetes mellitus over 40 with a total cholesterol > 135 mg/dL, regardless of LDL cholesterol Benefit/risk: - number needed to treat: - treating 14 patients for 4 years prevents 1 cardiovascular event Clinical trials: - CARDS trial suggests all high-risk type-2 diabetics should be treated with lipid-lowering therapy regardless of LDL cholesterol level [2] - meta-analysis (excluding Field study): [3] both primary & secondary events in patients with diabetes were reduced with lipid-lowering therapy (especially statins) - atorvastatin reduced myocardial infarction in patients with type 2 diabetes, but reduction not statiscally significant (see ASPEN study)

Related

ASPEN study Collaborative Atorvastatin Diabetes Study (CARDS)

General

pharmacology endocrinology

References

  1. Prescriber's Letter 11(6):34-35 2004 Lipid Control in Diabetes: Review of Clinical Practice Guidelines Detail-Document#: 200612
  2. Journal Watch 24(19):149, 2004 Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH; CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004 Aug 21;364(9435):685-96. PMID: 15325833 (subscription needed) http://www.prescribersletter.com
  3. Costa J et al, Efficacy of lipid-lowering drug treatment of diabetic and non-diabetic patients, Meta-analysis of randomized controlled trials. (meta-analysis that did NOT include Field trial) BMJ 2006; 332:1115 PMID: 16585050 - Reckless JPD Diabetes and lipid lowering. Where are we? We're now sure that statins cut cardiovascular risks in type 2 diabetes. BMJ 2006; 332:1103 PMID: 16585050