Should All Adults With Diabetes Take Statins?

One-third fewer people with type 1 or type 2 diabetes would suffer heart attacks or strokes if they took cholesterol-lowering statin drugs. Cardiovascular disease eventually kills two-thirds of people with diabetes notes Colin Baigent of England’s Medical Research Council. High levels of “bad” LDL Cholesterol play a major role.

Statin drugs 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, claims Baigent’s study. The researchers pooled data from 18,686 people with diabetes enrolled in 14 clinical trials of statins. The result: People with diabetes, whether 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, almost everybody with diabetes is a candidate for statin treatment – and at a large enough dose to give them a substantial reduction in LDL cholesterol,” says Baigent. “That is quite important, because the size of the benefit depends on the size of the cholesterol reduction.”

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, 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,” argues Cheung. “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 street.
“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.”

Cheung says everyone with diabetes should discuss cholesterol-lowering therapy with their doctors, but he does not think doctors should always recommend drug therapy.

However, Baigent disagrees. “Even if a person has a 1% per year risk of a major cardiovascular event, there is still a benefit from statins,” he says. “So for people whose risk increases over time – and after middle age, that is most everybody with diabetes – there is no point in not treating them with statins.”

Thank you Daniel J DeNoon

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