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The authors of a recent Lancet paper on a meta-analysis of 14 statin therapy trials1 have concluded that statins should be considered for all individuals with diabetes who are at sufficiently high risk of vascular events.

The Cholesterol Treatment Trialists’ Collaborators analysed data from 18,686 individuals with diabetes and 71,370 without the condition. During a mean follow up of 4.3 years, 3,247 major vascular events were noted in patients with diabetes. In this group, there was a 9% proportional reduction in all-cause mortality per mmol/l reduction in LDL cholesterol, which was similar to the 13% reduction in those without diabetes; this result reflected a significant reduction in vascular mortality in those individuals with diabetes. A 21% proportional reduction in major vascular events per mmol/l reduction in LDL cholesterol was also noted in patients with diabetes. The NICE technology appraisal on statins for the prevention of cardiovascular events2 recommends this therapy for all patients with diabetes and a history of vascular disease, and for all those without a known vascular disease in whom the predicted 10-year risk of major coronary event or stroke exceeds 20%. In this meta-analysis, the authors noted that among those with diabetes but without known vascular disease, the average risk of this outcome over 10 years would exceed the NICE 20% threshold. Therefore, they suggest that clinical guidelines might need revising so that a suitable statin regimen is considered for all people with diabetes, irrespective of lipid profile or whether vascular disease has developed.

If you would like to comment on this trial, or any Guidelines in Practice articles, please email me or visit www.eGuidelines.co.uk.

Julia Morris, Editor
julia.morris@mgp.ltd.uk

1. Cholesterol Treatment Trialists’ Collaborators. Lancet 2008: 371 (9607): 117–125.
2. National Institute for Health and Clinical Excellence. Statins for the prevention of cardiovascular events. Technology Appraisal 94. London: NICE, 2006.G