Statins for All Adults With Diabetes?
Study: One-Third Less Diabetes-Linked Heart Disease With Cholesterol-Lowering Drugs
Jan 10, 2008 -- One-third fewer
people with type 1 or type 2
diabetes would suffer heart attacks or strokes if they took cholesterol-lowering statin drugs, a U.K. study
Cardiovascular disease eventually
kills two-thirds of people with diabetes, notes Colin Baigent, FFPH, FRCP, of England's
Medical Research Council. High levels of "bad" LDL
cholesterol play a major role.
Statin drugs -- sold in the U.S.
as Crestor, Lescol XL, Lipitor, Mevacor, Pravachol, and Zocor --
lower LDL cholesterol. In people without diabetes, the drugs cut the risk of heart
attack, stroke, and other cardiovascular diseases. But it hasn't
been clear whether people with diabetes get as much benefit.
They do, Baigent and colleagues find. The researchers pooled data from
18,686 people with diabetes enrolled in 14 clinical trials of statins.
The result: People with diabetes, whether they are male or female, get just
as much benefit from statins as anyone else. If 1,000 people with diabetes took
statins for five years, 42 of them would avoid heart death, heart attack, or
coronary revascularization (bypass or stenting).
"We are saying that, after middle age, most everybody with diabetes is a
candidate for statin treatment -- and at a large enough dose to give them a
substantial reduction in LDL cholesterol," Baigent tells WebMD. "That
is quite important, because the size of the benefit depends on the size of the
The American Heart Association says it's best to have an LDL cholesterol
level of less than 100 mg/dL -- and calls LDL cholesterol levels of 100 to 129
mg/dL "near optimal/above optimal."
Baigent and colleagues calculate
that for every 39 mg/dL drop in LDL cholesterol, people with diabetes cut their
risk of major heart events by one-fifth. An average dose of statins cuts LDL
cholesterol by 57 mg/dL, which would lower this risk by one-third.
But not everyone with diabetes has the same heart risk, argues Bernard M.Y.
Cheung, MDBChir, PhD, FRCP, professor of clinical pharmacology and therapeutics
at the University of Birmingham, England.
"If you are crossing the street, you can choose to wear a helmet because
it may save your life in case you are knocked by a car. You are relatively
safer, although the absolute risk of this is quite low," Cheung tells
WebMD. "But if you are riding a motorcycle, the helmet is going to be
important because your risk of an accident is much greater."
Some people with diabetes have a lower heart-disease risk than others. For
them, Cheung says, taking statins would be like wearing a helmet to cross the
"It was once believed that the mere fact of having diabetes gives a
person the same risk of heart attack as a person who had a heart attack
before," Cheung says. "We are now treating people's diabetes much
better than before, and their baseline risk of heart
disease is lower than before."