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

^[1]^[2]^[3]

Introduction

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

number needed to treat:
- treating 14 patients for 4 years prevents 1 cardiovascular event

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)

↑ Prescriber's Letter 11(6):34-35 2004 Lipid Control in Diabetes: Review of Clinical Practice Guidelines Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200612&pb=PRL
↑ ^2.0 ^2.1 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15325833 (subscription needed) <Internet> http://www.prescribersletter.com
↑ ^3.0 ^3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/16585050