Prescribing Advice for GPs

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Statins for all diabetics?

The Lancet has published the results of a prospective meta-analysis of 14 statin trial in patients with diabetes. The BBC has also reported this story.

The analysis included data from 14 trials (inclusion criteria excluded small studies, unpublished studies and those in languages other than English) containing data for 18,686 patients with diabetes. Outcomes were assessed in relation to a reduction in low-density lipoprotein cholesterol (LDL-C) of 1mmol/L. The results are as follows:

  • 13% relative risk reduction in vascular mortality [0.87, 95%CI 0.76 - 1.00, p=0.008]
  • 21% relative risk reduction in major vascular events [0.79, 95%CI 0.72 - 0.86, p<0.0001]
  • 22% relative risk reduction in myocardial infarction or coronary death [0.78, 95%CI 0.69 - 0.87, p<0.0001]

The authors conclude that, "Statin therapy should be considered for all diabetic individuals who are at sufficiently high risk of vascular events". An accompanying editorial notes that the results are reassuring but is critical of some aspects of the paper. The editorial also points out that cardiovascular risk reduction should not neglect the importance of lifestyle changes including smoking cessation, healthy diet and regular exercise.

Action: Clinicians should continue to formally assess cardiovascular risk in patients with diabetes. Statin therapy should be considered a core part of a wider treatment strategy to include a healthy lifestyle, blood pressure control, blood glucose control and lipid management.

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