Source: Hong Kong Med J  |  Posted 6 years ago

By Norra MacReady

PRAGUE, CZECH REPUBLIC -- May 2, 2005 -- People with diabetes require intensive statin therapy even if their levels of low-density lipoprotein (LDL) cholesterol is within the normal range, according to a presentation here at the 75[^]th[] European Atherosclerosis Society Congress.

John Betteridge, MD, professor of endocrinology and metabolism, University College London, London, United Kingdom, said he concurred with the recommendation issued recently by the American Diabetes Association. These recommendations state that diabetics who are older than 40 years of age and whose total cholesterol exceeds 3.5 mmol/L (135 mg/dL) should be placed on statin therapy to achieve a 30% to 40% reduction in LDL level, regardless of their baseline LDL level and even if they do not have overt cardiovascular disease.

In the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction (PROVE-IT) study, treatment with atorvastatin 80 mg/day lowered LDL cholesterol levels to a median of 1.6 mmol/L (62 mg/dL) in diabetics and nondiabetics alike, compared to 2.5 mmol/L (97 mg/dL) with the standard pravastatin 40-mg regimen. The PROVE-IT study included 734 diabetic patients among the 4162 people who had been hospitalised for acute coronary syndrome, Dr. Betteridge said.

Among patients taking atorvastatin, the hazard ratio for a cardiovascular event was 16% less than it was for patients on pravastatin after the mean follow-up period of 24 months, a significant difference (Cannon C. et al. N Engl J Med 2004;350:1495-1504).

Dr. Betteridge urged physicians to follow the recommendations in the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults released by the US National Cholesterol Education Program. This panel established a goal LDL cholesterol level of < 1.8 mmol/L (<69 mg/dL) for patients with diabetes and cardiovascular disease, regardless of their baseline LDL cholesterol level.

"The message is, the lower the LDL the better, particularly in our patients with diabetes," he said.

Raising the high-density lipoprotein (HDL) cholesterol level also seems to help reduce cardiovascular risk in diabetics, Dr. Betteridge said.

In the Veterans Administration HDL Intervention Trial, 2531 men with cardiovascular disease were randomised to receive gemfibrozil in a dose of 1200 mg per day or a placebo. The men taking gemfibrozil experienced a 6% increase in HDL cholesterol as well as a 31% reduction in serum triglycerides compared with the men in the placebo group.

After a mean follow-up period of 5 years, gemfibrozil was associated with a 24% decline in the combined outcomes of death from coronary heart disease, nonfatal myocardial infarction, and stroke (Rubins et al. N Engl J Med 1999;341:410-418).

Further analysis in this study showed that diabetic patients benefited as much as nondiabetics from the drug intervention, Dr. Betteridge said.

[Presentation title: Targeted Treatment of Diabetic Dyslipidemia: Background and Current Approaches.]