Statin Treatment
Initiating Statin Therapy Based on Risk
Patients with type 2 diabetes have an
increased prevalence of lipid abnormalities,
contributing to their high risk of
CVD. Multiple clinical trials have demonstrated
significant effects of pharmacological
(primarily statin) therapy on CVD
outcomes in individual subjects with
CHD and for primary CVD prevention
(29,30). Subgroup analyses of diabetic
patients in larger trials (31–35) and trials
in patients with diabetes (36,37)
showed significant primary and secondary
prevention of CVD events 1/2 CHD
deaths in patients with diabetes. Metaanalyses,
including data from over
18,000 patients with diabetes from 14
randomized trials of statin therapy
(mean follow-up 4.3 years), demonstrate
a 9% proportional reduction in all-cause
mortality and 13% reduction in vascular
mortality, for each mmol/L reduction in
LDL cholesterol (38). As in those without
diabetes, absolute reductions in objective
CVD outcomes (CHD death and nonfatal
MI) are greatest in people with high baseline
CVD risk (known CVD and/or very high
LDL cholesterol levels), but the overall benefits
of statin therapy in people with diabetes
at moderate or high risk for CVD are
convincing (39,40). Statins are the drugs of
choice for LDL cholesterol lowering and cardioprotection.
Statin TreatmentInitiating Statin Therapy Based on RiskPatients with type 2 diabetes have anincreased prevalence of lipid abnormalities,contributing to their high risk ofCVD. Multiple clinical trials have demonstratedsignificant effects of pharmacological(primarily statin) therapy on CVDoutcomes in individual subjects withCHD and for primary CVD prevention(29,30). Subgroup analyses of diabeticpatients in larger trials (31–35) and trialsin patients with diabetes (36,37)showed significant primary and secondaryprevention of CVD events 1/2 CHDdeaths in patients with diabetes. Metaanalyses,including data from over18,000 patients with diabetes from 14randomized trials of statin therapy(mean follow-up 4.3 years), demonstratea 9% proportional reduction in all-causemortality and 13% reduction in vascularmortality, for each mmol/L reduction inLDL cholesterol (38). As in those withoutdiabetes, absolute reductions in objectiveCVD outcomes (CHD death and nonfatalMI) are greatest in people with high baselineCVD risk (known CVD and/or very highLDL cholesterol levels), but the overall benefitsof statin therapy in people with diabetesat moderate or high risk for CVD areconvincing (39,40). Statins are the drugs ofchoice for LDL cholesterol lowering and cardioprotection.
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