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Pravastatin Treatment Reduces Risk Of Cardiovascular Events For Patients With Diabetes Or Impaired Fasting Glucose

Cardiovascular complications are the leading cause of morbidity and mortality for people with diabetes; as many as 80% of patients with type 2 diabetes die from cardiovascular events. Unfortunately, clinical trials have been unable to demonstrate a substantial reduction of these events in response to blood glucose control.

"The role of other therapies, such as lipid lowering, in preventing further vascular disease in diabetes needs to be defined," writes Anthony Keech, MBBS, FRACP, of the National Health Medical Research Council Clinical Trials Centre, Sydney, Australia.

Dr. Keech and colleagues performed a sub-study using data from the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial to measure the effects of pravastatin therapy on major coronary heart disease (CHD) events in patients with diabetes or impaired fasting glucose. The trial had previously demonstrated that cholesterol reduction with pravastatin reduced mortality and CHD events in 9014 (ages 31 to 75) patients with CHD and total cholesterol 4.0-7.0 mmol/L.

All LIPID participants had experienced a myocardial infarction or hospital admission for unstable angina 3 to 36 months before entering the study. Among these, 1077 had diabetes (fasting plasma glucose >7.0 mmol/L), and 940 were classified as having impaired fasting glucose (IFG; fasting plasma glucose 6.1-6.9 mmol/L). Placebo was assigned to 1001 of these participants and the remaining 1016 received pravastatin 40 mg daily.

Pravastatin therapy significantly reduced the risk of CHD events for participants with diabetes or IFG, similar to the benefit observed in participants with normal fasting glucose. The relative risk of a major CHD event was reduced from 23.4 to 19.5% in diabetics, 17.8 to 11.8% in the IFG participants, and 15.9 to 12.3% in those with normal fasting glucose. Moreover, the relative risk of any cardiovascular event was reduced from 52.7 to 45.2% for diabetics patients, 45.7 to 37.1% for the IFG group, and 38.5 to 34.5% for participants with normal fasting glucose.

Notably, pravastatin more effectively reduced the risk of stroke for patients with diabetes (relative risk reduction; 39%) or IFG (42%) than those with normal fasting glucose (19%).

"The LIPID study reliably confirms that for patients with established CHD, the absolute benefits of statin treatment are substantially greater for those with abnormal fasting glucose," the researchers conclude.

Previous studies had reported that pravastatin treatment could reduce the risk of developing new diabetes. However, a similar risk reduction was not detected in the present analysis.

"This [previous] finding could be plausibly related to random imbalances at baseline," suggest Dr. Keech.

Diabetes Care 2003 Oct;26:10:2713-2721. "Secondary Prevention of Cardiovascular Events With Long-Term Pravastatin in Patients With Diabetes or Impaired Fasting Glucose: Results from the LIPID trial"

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