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New Guidelines Recommend Statins For Type 2’s Without Elevated Lipids

Based on a review of the literature, these guidelines reflect evidence collected from 12 lipid-lowering studies of diabetic patients, 6 that addressed primary prevention and 8 that reported on secondary prevention.

To prevent or diminish microvascular and macrovascular complications associated with type 2 diabetes, particularly in premenopausal women, the American College of Physicians (ACP) has developed a set of recommendations on lipid control.

Tailored to address the need for lipid control in 2 categories of patients -- diabetics without known coronary disease (primary prevention) and diabetics with established coronary disease (secondary prevention)-- the 4 recommendations include 1) use of lipid-lowering therapy for secondary prevention of cardiovascular disease for diabetic patients with known coronary artery disease; 2) the use of statins for primary prevention in diabetic patients with significant cardiovascular risk factors (eg, hypertension, smoking, older than 55 years); 3) use of moderate doses of a statin once lipid-lowering therapy is initiated; and 4) no routine monitoring of liver function tests or muscle enzymes in patients taking statins, except for patients who have abnormal liver function tests or myopathy at baseline or who are on other drugs that interact with statins.

Based on a review of the literature, these guidelines reflect evidence collected from 12 lipid-lowering studies of diabetic patients, 6 that addressed primary prevention and 8 that reported on secondary prevention. Pooled analysis of the primary prevention studies showed that lipid-lowering therapy was associated with a 0.78 (95% CI, 0.67 to 0.89) relative risk and 0.03 (95% CI, 0.01 to 0.04) absolute risk reduction for cardiovascular events. The relative risk for cardiovascular events with lipid-lowering therapy was similar in pooled analysis of the secondary prevention studies (0.76 [95% CI, 0.59 to 0.93]), although the absolute risk reduction in these studies was more than twice as high (0.07 [95% CI, 0.03 to 0.12]).

The studies also indicated statins as the agents of choice for lipid-lowering therapy in patients with type 2 diabetics, based on good evidence on their empirical use in moderate doses in patients at risk for cardiovascular disease as well as their good safety profile.

No evidence was found on the efficacy of targeting specific levels of low-density lipoprotein (LDL) or total cholesterol levels in patients with type 2 diabetes. The guidelines therefore suggest that initiating treatment to target LDL or total cholesterol should be a shared decision between physician and patient.
  These guidelines are intended for all physicians who care for patients with type 2 diabetes. The authors note, however, that the guidelines are only meant as guides and "are not intended to override clinicians' judgement."
Ann Intern Med 2004 Apr 20;140:8:644-9
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