OBJECTIVE: To evaluate the clinical benefit of lipid lowering drug treatment in patients with and without diabetes mellitus, for primary and secondary prevention. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Cochrane, Medline, Embase, and reference lists up to April 2004. STUDY SELECTION: Randomised, placebo controlled, double blind trials with a follow-up of at least three years that evaluated lipid lowering drug treatment in patients with and without diabetes mellitus. DATA EXTRACTION: Two independent reviewers extracted data. The primary outcome was major coronary events defined as coronary heart disease death, non-fatal myocardial infarction, or myocardial revascularisation procedures. RESULTS: Twelve studies were included. Lipid lowering drug treatment was found to be at least as effective in diabetic patients as in non-diabetic patients. In primary prevention, the risk reduction for major coronary events was 21% (95% confidence interval 11% to 30%; P < 0.0001) in diabetic patients and 23% (12% to 33%; P = 0.0003) in non-diabetic patients. In secondary prevention, the corresponding risk reductions were 21% (10% to 31%; P = 0.0005) and 23% (19% to 26%; P < or = 0.00001). However, the absolute risk difference was three times higher in secondary prevention. When results were adjusted for baseline risk, diabetic patients benefited more in both primary and secondary prevention. Blood lipids were reduced to a similar degree in both groups. CONCLUSIONS: The evidence that lipid lowering drug treatment (especially statins) significantly reduce cardiovascular risk in diabetic and non-diabetic patients is strong and suggests that diabetic patients benefit more, in both primary and secondary prevention. Future research should define the threshold for treatment of these patients and the desired target lipid concentrations, especially for primary prevention.
OBJECTIVE: To evaluate the clinical benefit of lipid lowering drug treatment in patients with and without diabetes mellitus, for primary and secondary prevention. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Cochrane, Medline, Embase, and reference lists up to April 2004. STUDY SELECTION: Randomised, placebo controlled, double blind trials with a follow-up of at least three years that evaluated lipid lowering drug treatment in patients with and without diabetes mellitus. DATA EXTRACTION: Two independent reviewers extracted data. The primary outcome was major coronary events defined as coronary heart disease death, non-fatal myocardial infarction, or myocardial revascularisation procedures. RESULTS: Twelve studies were included. Lipid lowering drug treatment was found to be at least as effective in diabeticpatients as in non-diabeticpatients. In primary prevention, the risk reduction for major coronary events was 21% (95% confidence interval 11% to 30%; P < 0.0001) in diabeticpatients and 23% (12% to 33%; P = 0.0003) in non-diabeticpatients. In secondary prevention, the corresponding risk reductions were 21% (10% to 31%; P = 0.0005) and 23% (19% to 26%; P < or = 0.00001). However, the absolute risk difference was three times higher in secondary prevention. When results were adjusted for baseline risk, diabeticpatients benefited more in both primary and secondary prevention. Blood lipids were reduced to a similar degree in both groups. CONCLUSIONS: The evidence that lipid lowering drug treatment (especially statins) significantly reduce cardiovascular risk in diabetic and non-diabeticpatients is strong and suggests that diabeticpatients benefit more, in both primary and secondary prevention. Future research should define the threshold for treatment of these patients and the desired target lipid concentrations, especially for primary prevention.
Authors: H B Rubins; S J Robins; D Collins; C L Fye; J W Anderson; M B Elam; F H Faas; E Linares; E J Schaefer; G Schectman; T J Wilt; J Wittes Journal: N Engl J Med Date: 1999-08-05 Impact factor: 91.245
Authors: B J Hoogwerf; A Waness; M Cressman; J Canner; L Campeau; M Domanski; N Geller; A Herd; A Hickey; D B Hunninghake; G L Knatterud; C White Journal: Diabetes Date: 1999-06 Impact factor: 9.461
Authors: R B Goldberg; M J Mellies; F M Sacks; L A Moyé; B V Howard; W J Howard; B R Davis; T G Cole; M A Pfeffer; E Braunwald Journal: Circulation Date: 1998-12-08 Impact factor: 29.690
Authors: Kunal N Karmali; Donald M Lloyd-Jones; Mark A Berendsen; David C Goff; Darshak M Sanghavi; Nina C Brown; Liliya Korenovska; Mark D Huffman Journal: JAMA Cardiol Date: 2016-06-01 Impact factor: 14.676
Authors: David Melzer; Anna Murray; Alison J Hurst; Michael N Weedon; Stefania Bandinelli; Anna Maria Corsi; Luigi Ferrucci; Guiseppe Paolisso; Jack M Guralnik; Timothy M Frayling Journal: BMC Med Date: 2006-12-20 Impact factor: 8.775
Authors: Giovanni F M Strippoli; Sankar D Navaneethan; David W Johnson; Vlado Perkovic; Fabio Pellegrini; Antonio Nicolucci; Jonathan C Craig Journal: BMJ Date: 2008-02-25