Role of statins for the primary prevention of cardiovascular disease in patients with type 2 diabetes

The authors of this American article review and evaluate the major statin trials that included a significant number of patients with diabetes without pre-existing coronary heart disease (CHD). They also discuss the role statins should play in primary prevention. The following primary prevention trials are discussed in the article:

• Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)
• Heart Protection Study (HPS)
• Anglo–Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT-BPLA)
• Collaborative atorvastatin diabetes study (CARDS)
• The atorvastatin study for prevention of coronary heart disease endpoints in non-insulin-dependent diabetes mellitus (ASPEN)

Guidelines from the American Diabetes Association (ADA) recommend statin therapy in the majority of patients with diabetes. The authors note that the first 4 studies above (which included a significant number of patients with diabetes and no history of CHD) have had an impact on treatment guidelines. However, they also add that these studies had various methodological flaws and some non-significant results. ASPEN was the most recent trial published since the ADA guidelines were issued. This trial found that in patients with diabetes at lower CHD risk, atorvastatin 10 mg was not superior to placebo in reducing time to the first major CV event or procedure.

The authors conclude, “Current ADA recommendations may be too aggressive as available evidence suggests that the decision to initiate pharmacotherapy with a statin in patients with type 2 diabetes mellitus who do not have pre-existing CHD should be individualised rather than based solely on the diagnosis of type 2 diabetes mellitus.”

Am J Health-Syst Pharmacy 2007; 64: 1603-10