Statins Slash Heart Disease Risk for Diabetics

Cholesterol-cutting drugs reduce dangers even in those with "normal" cholesterol

(HealthDay is the new name for HealthScoutNews.)

THURSDAY, June 12, 2003 (HealthDayNews) -- Supporting their growing status as the aspirin of the 21st century, a new study shows statins can slash the risk of strokes, heart attacks and other cardiovascular problems in diabetics -- even if they don't have high cholesterol.

The study found giving these cholesterol-lowering drugs to people with diabetes cut their risk of heart and vessel trouble by about 25 percent. The benefits of lowering cholesterol were strong for both those with the blood sugar disease but no warning signs of cardiovascular illness and those whose "bad" cholesterol fell in the accepted normal range.

That's not surprising, the researchers say, because very few people in industrialized countries have "normal" cholesterol. "We've all got levels that are too high, and this study demonstrates that absolutely unequivocally," says research leader Dr. Rory Collins, of the University of Oxford, England.

An estimated 100 million people worldwide have diabetes, putting them at increased risk for heart attacks and strokes. If each of them were to take statins routinely, Collins says, as many as 1 million of these life-threatening events could be prevented each year.

"The logical conclusion is to think about statins in the way we think about aspirin," Collins says. "Now we've got unequivocal evidence that in people at high risk [for heart and vessel disease], by lowering their cholesterol we will lower their risk, irrespective of how low their cholesterol is to begin with." A report on the findings appears in the June 14 issue of The Lancet.

Collins' group compared the effects of routine statin use and no therapy in more than 20,000 Britons. Of those, roughly 6,000 had diabetes -- mostly the adult-onset, or type 2, form of the condition -- while the rest had varying degrees of blocked arteries but no blood sugar problems. Half the volunteers were given 40 milligrams a day of the drug simvastatin, sold as Zocor by Merck & Co., which helped fund the work. Half were given sugar pills.

Over the next five years, 601 diabetics taking the statin suffered a first-time heart attack or stroke or required procedures to fix vessel blockages. The figure was 748 in the group on sugar pills -- a difference of 22 percent. For those who'd already had one of these events, the cholesterol drug significantly reduced their chances of suffering a repeat attack.

In the 2,900-odd diabetics without blocked blood vessels at the start of the trial, the reduction was even greater: 33 percent fewer people in this group developed heart or vessel problems.

And among diabetics with low-density lipoprotein (LDL), the dangerous form of cholesterol, that wasn't high, taking the daily statin dropped their risk of developing cardiovascular trouble by 27 percent compared with those on dummy treatment. Collins says the benefits of the drug persisted even in diabetics with LDL counts of 80 milligrams per deciliter of blood, a figure generally thought to be excellent.

"Our hypothesis was that irrespective of where you started in terms of your LDL cholesterol, lowering it by the same absolute amount -- an average of 40 milligrams per deciliter -- should reduce the risk of [heart and vessel problems] by the same proportion," Collins says.

Collins and his colleagues recommend that everyone with diabetes who is at high risk of heart or vessel trouble be put on a statin.

But Dr. Lars Lindholm, a health economist at the Umea University Hospital in Sweden and author of an editorial accompanying the journal article, suggests everyone with type 2 diabetes "should be given a statin, regardless of their cholesterol value."

While statins may be heart-friendly like aspirin, they're not nearly as cheap -- yet. A month's supply of 40-milligram Zocor pills costs $117 on, though the drug is available generically in Canada for somewhat less. As the drug and its kin come off patent, Lindholm writes, "this prescription may now be possible."

More information

Try the American Diabetes Association or the American Heart Association.

SOURCES: Rory Collins, M.D., professor, medicine and epidemiology, University of Oxford, England; June 14, 2003, The Lancet
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