OBJECTIVE: To provide an update on lipid management and recent modifications in cholesterol guidelines for use of
hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), specifically in patients with diabetes.

DATA SOURCES: Studies and guidelines were identified through a MEDLINE search (1996-April 2005).

STUDY SELECTION AND DATA EXTRACTION: Studies were selected for review if the primary treatment intervention was a statin, at least 4% of the study population held a diagnosis of diabetes, and diabetes subgroup analysis was available.

DATA SYNTHESIS: The Heart Protection Study demonstrated an approximately 25% relative risk reduction of a first coronary event in patients with diabetes, a reduction similar to those without diabetes. In subjects with diabetes, a significant reduction in coronary events was noted regardless of the baseline cholesterol level. The Collaborative Atorvastatin Diabetes Study demonstrated a 37% relative risk reduction in the primary prevention of cardiovascular morbidity in patients with diabetes.

CONCLUSIONS: Based on the current literature, a low-density lipoprotein cholesterol (LDL-C) level <100 mg/dL remains an appropriate goal for patients with diabetes in the absence of established cardiovascular disease. For higher-risk patients, such as those with diabetes and a history of cardiovascular disease, a more stringent LDL-C goal of <70 mg/dL is an option according to current clinical trial evidence. At least a 30-40% reduction in the LDL-C level is advisable when initiating statin therapy.



Key Words: diabetes, lipids, statins

Published Online, August 23, 2005. www.theannals.com, DOI 10.1345/aph.1G069

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ACPE UNIVERSAL PROGRAM NUMBER: 407-000-05-030-H01