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http://bmj.com/cgi/content/full/326/7403/1348-b
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BMJ 2003;326:1348 (21 June)
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 Collections under
which this article appears: Drugs:
cardiovascular system Diabetes
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Susan Mayor
London
Statin treatment reduces major coronary events, revascularisations, and stroke by nearly a quarter in people with diabetes regardless of whether they have occlusive arterial disease or raised cholesterol. This was the finding from a major study published last week.
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The Medical Research Council/British Heart Foundation heart protection study randomly allocated 5973 UK adults (aged 40-80 years) with a history of diabetes—90% with type 2 diabetes and 10% with type 1—to 40 mg simvastatin daily or a matching placebo for five years. Results showed that the combined end point of first major coronary event, stroke, and revascularisation was reduced by 22% (95% confidence interval 13% to 30%) in patients treated with simvastatin compared with those given placebo.
A total of 601 (20.2%) first events occurred in the simvastatin group, 748 (25.1%) in the placebo group (P<0.0001). The researchers, the Heart Protection Study Collaborative Group, argued that as compliance was not 100% in the trial, full compliance with the daily statin regimen would probably reduce major vascular events by even more than seen in the study—by about a third, they estimated ( Lancet 2003;361: 2005-16).
Reductions in cardiovascular events with simvastatin were similar regardless of whether patients had raised cholesterol levels at baseline. Nearly half (2426 patients) of the study group had pretreatment LDL (low density lipoprotein) cholesterol levels below 3.0 mmol/l. Statin treatment reduced events in this group by 27% (13% to 40%; P=0.0007). The 2912 patients without diagnosed occlusive arterial disease also shared similar risk reduction, of 33% (17% to 45%; P=0.0003).
Lead researcher Rory Collins, professor of medicine and epidemiology at the clinical trials service unit and epidemioglogical studies unit at the Radcliffe Infirmary, Oxford, said: "The results provide direct evidence that cholesterol lowering therapy is beneficial for people with diabetes even if they do not already have manifest coronary disease or high cholesterol concentrations."
He argued that his team supported renewed emphasis on the control of macrovascular complications of diabetes other than hyperglycaemia: "The study showed that the benefits of cholesterol lowering therapy were additional to those of other cardioprotective treatments."
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cardiovascular system Diabetes
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© 2003 BMJ Publishing Group Ltd
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