THURSDAY, Aug. 19, 2004 (HealthDayNews) -- Giving cholesterol-lowering statin drugs to people with type 2 diabetes prevents heart attack and stroke and saves lives, even if they don't have high cholesterol, a new study finds.
And while statins shouldn't be prescribed indiscriminately for people with type 2 diabetes -- the kind that generally develops during adulthood -- "the vast majority of them warrant consideration for treatment," said Dr. Helen M. Colhoun, a professor of genetic epidemiology at University College Dublin, in Ireland.
Colhoun is lead author of the report, which appears in the Aug. 21 issue of The Lancet.
"The decision should not be made on the basis of cholesterol levels," Colhoun said. "Even patients who don't have high cholesterol levels benefit."
Rather, she said, a decision to prescribe a statin for someone with type 2 diabetes should be made by assessing total risk of cardiovascular disease, based on such factors as blood pressure, smoking and obesity. Since type 2 diabetes itself is a major risk factor for cardiovascular disease, most people with the disease are in the high-risk group, she added.
The findings might call for a change in current guidelines for statin treatment of people with type 2 diabetes, Colhoun said.
American Diabetes Association guidelines say the drugs should be given to patients with levels of LDL cholesterol -- the "bad" kind that clogs arteries -- of 130 or higher, she noted. "But about 65 percent of patients in the trial had readings below that level and still benefited," she said.
The trial included 2,838 people aged 40 and older with type 2 diabetes who were treated at 132 centers in Great Britain and Ireland. Half were prescribed atorvastatin (Lipitor), while the other half received a placebo. The trial was scheduled to run for six or more years, but was cut short by two years because evidence of the benefit from statin treatment was so strong, Colhoun said.
The incidence of acute coronary disease was 36 percent lower in the statin group. The risk of stroke was 48 percent lower. And the overall death rate was 27 percent lower. No adverse side effects were seen in those taking the drug.
"The debate about whether all people with this disorder warrant statin treatment should now focus on whether any patients are at sufficiently low risk for this treatment to be withheld," the researchers wrote.
A more cautious approach is urged by Dr. Abhimanyu Garg, chief of the Division of Nutrition and Metabolic Diseases at the University of Texas Southwestern Medical Center at Dallas.
"What I suggest is someone whose LDL cholesterol is high deserves statin therapy," said Garg, who wrote an accompanying editorial in the journal. "If levels are lower, I would try diet, exercise and weight loss and improvement of diabetes to get cholesterol down to a desirable level, then go to statins if those measures do not work."
One reason for caution is that statins can cause side effects, such as liver problems, Garg said. Another, he said, is that the new study, like most others, did not include a group of people in whom incidence of type 2 diabetes is increasing -- those under 40.
"We are now concerned about an epidemic of type 2 diabetes in people under 40," Garg said, yet no studies of statin treatment in those people have been done.
"It is still prudent to assess an individual's risk-benefit ratio before recommending long-term statin therapy," Garg wrote.
More information
The American Heart Association has more about statins and other cholesterol-lowering drugs.
