Statin therapy may lower risk for cardiovascular disease in patients with type 2 diabetes even when they do not have elevated cholesterol levels, according to an article in the August 21st issue of the Lancet.

Helen Colhoun and her British and Irish colleagues evaluated the effectiveness of atorvastatin for primary prevention of major cardiovascular events in patients with type 2 diabetes without high concentrations of low-density lipoprotein cholesterol. Roughly 2800 patients (aged 40-75 years) were randomized to placebo (1410 patients) or atorvastatin (1428 patients). Patients had no previous history of cardiovascular disease and had low low-density lipoprotein cholesterol concentrations (around 4 millimoles per liter or less).

Average follow-up was roughly 4 years after study enrollment. The primary outcome measure of the study-acute coronary heart disease events, coronary revascularization procedure, or stroke-was reduced by around a third in patients given atorvastatin compared with those given placebo. Atorvastatin reduced the death rate by 27% compared with placebo. Strokes were reduced by 48%.

Professor Colhoun concluded for the authors that atorvastatin 10 mg daily is safe and efficacious in reducing the risk of first cardiovascular disease event, including stroke, in patients with type 2 diabetes who do not have high low-density cholesterol. Thus, she felt there is no current justification available for having a particular threshold level as the sole arbiter of which patients with type 2 diabetes should receive statins. The debate about whether all people with the disorder warrant statin treatment should now focus on whether any patients are at sufficiently low risk for the treatment to be withheld.

In an accompanying commentary, Abhimanyu Garg MD, wrote “While landmark trials like CARDS increase our confidence in lipid-lowering drug therapy for prevention of coronary heart disease in patients with type 2 diabetes, it is still prudent to assess an individual’s risk-benefit ratio before recommending long-term statin therapy. Thus more models need to be developed, such as the UK Prospective Diabetes Study risk engine, to assess coronary heart disease risk in patients with type 2 diabetes. For patients with type 2 diabetes at moderate to low risk of coronary heart disease, maximal lowering of lipids with diet, exercise, weight loss, and rigorous glycemic control must be attempted before considering lipid-lowering drugs”.