Most people with diabetes would benefit from statins

Most people who have diabetes would benefit from statin therapy, even if they have not yet developed symptoms or signs of vascular disease such as heart disease and stroke.

New research has found that statins would be beneficial even if the person with diabetes did not have high cholesterol levels. The study is published in The Lancet.

Statins are known to be beneficial in a wide range of people at increased risk of heart disease or stroke. But there had previously been limited information about the effects of statins in people with diabetes.

This new study examined the effects of statin therapy in around 19,000 people with diabetes from 14 previously completed statin trials, and compared these with the effects of statins in the 71,000 trial participants who did not have diabetes.

People with diabetes have a much greater risk of vascular disease than those of similar age who do not have diabetes. This review demonstrated that statins reduce the risks in a wide range of people with diabetes. It found that a standard statin regimen would prevent about one third of heart attacks and strokes in people with diabetes.

This study was jointly coordinated by scientists from the Clinical Trial Service Unit (CTSU) at the University of Oxford and the National Health Medical Research Council (NHMRC) Clinical Trials Centre (CTC) at the University of Sydney, Australia. Funding was provided by the Medical Research Council (MRC) and the British Heart Foundation (BHF) in the UK, and the National Heart Foundation (NHF) in Australia.

The Medical Research Council scientist who coordinated the study team in Oxford, Professor Colin Baigent, said: "This study shows that statin drugs prevent heart attacks and strokes in a much wider range of people with diabetes than is currently being treated. A statin regimen sufficient to produce a substantial reduction in LDL cholesterol should be considered for most people with diabetes. Statin therapy is only likely to be inappropriate when the risk of a heart attack or stroke is very low, as in children, or when there are concerns about drug safety, as in pregnancy."

Dr Patricia Kearney, who helped coordinate the study in Oxford, said: "The benefits of statins were similar in all the different types of people with diabetes we studied, including those without known heart disease, women, the elderly, those with mild kidney disease, and those with below average blood cholesterol levels. The largest benefits were seen among those at greatest risk of a heart attack or stroke."

Professor Tony Keech, who coordinated the study team in Sydney, said: "Statins are often prescribed in relatively small doses which may only reduce cholesterol modestly. Our results indicate that the benefits of statins in people with diabetes appear directly proportional to the size of the reduction in cholesterol produced by treatment. So, bigger cholesterol reductions with more intensive treatment regimens in people with diabetes should lead to greater benefits."

The commonest type of diabetes, Type II diabetes, tends to develop after middle-age, and is associated with obesity. Type I diabetes is less common and is caused by a lack of insulin. It develops in childhood or young adulthood. Although most of the evidence in this study related to people with type II diabetes, the study also demonstrated for the first time that statins reduce the risk of a heart attack or stroke among people with type I diabetes.