Statin therapy in the management of diabetes mellitus; how relevant?

Abstract

Diabetes is associated with the development of premature cardiovascular disease. There have been many clinical trials of statin treatment conducted in patients with Coronary Heart Disease (CHD). Taking a closer look at the subset of those patients with diabetes mellitus puts no doubt on the beneficial effect of lowering cholesterol with statin in these patients. Earlier studies done dwell more on cholesterol reduction with statins in patients with CHD but without diabetes hence no strong supporting evidence was there to justify the use of statins in diabetic patients without cardiovascular disease. We search medline for studies on cholesterol reduction and cardiovascular risk reduction in diabetic patients. We found three secondary prevention trials (4S, CARE and LIPID); four primary prevention trials (ASCOT-LLA, CARDS, WOSCOPS and TexCaps); two mixed prevention trials (HPS and ASPEN); three trials (PROVE-IT, TNT and A to Z) that seek to evaluate whether intensive or moderate lipid lowering with statins will prevent cardiovascular risk and to what extent. Treatment decisions should be based on the reduction of absolute risk and not on the reduction in relative risk. Patients suffering from diabetes mellitus will incur a huge cost if they were to be commenced on statin from the day the diagnosis of diabetes was made. With the rising incidence of diabetes worldwide, statins should be targeted to those patients with diabetes mellitus who are most likely to benefit from it. Type 2 DM patients with metabolic syndrome or those with mild to moderate cardiovascular risk will benefit from statin therapy. Clinical benefits stand to be derived from statin therapy if moderate reduction of risk can be achieved in patients that are classified as having high cardiovascular risk. What this means is that all patients eligible to be enrolled in the HPS or CARDS study should be on statin treatment.