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© 2003 by the American Diabetes Association, Inc.
Clinical Care/Education/Nutrition |
Secondary Prevention of Cardiovascular Events With Long-Term Pravastatin in Patients With Diabetes or Impaired Fasting Glucose
Results from the LIPID trial
1 National Health Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
2 Wesley Medical Centre, Brisbane, Australia
3 St. Vincent’s Hospital, Melbourne, Australia
4 Royal Melbourne Hospital, Melbourne, Australia
5 National Heart Foundation, Melbourne, Australia
Address correspondence and reprint requests to Professor Anthony Keech, NHMRC Clinical Trials Centre, Mallett Street Campus, University of Sydney, NSW 2006, Australia. E-mail: enquiry{at}ctc.usyd.edu.au
OBJECTIVE—Diabetes, a major health problem worldwide, increases the risk of cardiovascular disease and its associated mortality. Evidence of the overall benefits of lipid modification in this area is needed.
RESEARCH DESIGN AND METHODS—The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial showed that cholesterol-lowering treatment with pravastatin reduced mortality and coronary heart disease (CHD) events in 9,014 patients aged 31–75 years with CHD and total cholesterol 4.0–7.0 mmol/l. We measured the effects of pravastatin therapy, 40 mg/day over 6.0 years, on the risk of CHD death or nonfatal myocardial infarction and other cardiovascular outcomes in 1,077 LIPID patients with diabetes and 940 patients with impaired fasting glucose (IFG).
RESULTS—In patients allocated to placebo, the risk of a major CHD event was 61% higher in patients with diabetes and 23% higher in the IFG group than in patients with normal fasting glucose, and the risk of any cardiovascular event was 37% higher in the diabetic group and 19% higher in the IFG group. Pravastatin therapy reduced the risk of a major CHD event overall from 15.9 to 12.3% (relative risk reduction [RRR] 24%, P < 0.001) and from 23.4 to 19.6% in the diabetic group (19%, P = 0.11); in the diabetic group, the reduction was not significantly different from the reductions in the other groups. Pravastatin reduced the risk of any cardiovascular event from 52.7 to 45.2% (21%, P < 0.008) in patients with diabetes and from 45.7 to 37.1% (26%, P = 0.003) in the IFG group. Pravastatin reduced the risk of stroke from 9.9 to 6.3% in the diabetic group (RRR 39%, CI 7–61%, P = 0.02) and from 5.4 to 3.4% in the IFG group (RRR 42%, CI -9 to 69%, P = 0.09). Pravastatin did not reduce the incidence of diabetes. Over 6 years, pravastatin therapy prevented one major CHD event (CHD death or nonfatal myocardial infarction) in 23 patients with IFG and 18 patients with diabetes. A meta-analysis of other major trials confirmed the high absolute risks of diabetes and IFG and the absolute benefits of statin therapy in these patients.
CONCLUSIONS—Cholesterol-lowering treatment with pravastatin therapy prevents cardiovascular events, including stroke, in patients with diabetes or IFG and established CHD.
Abbreviations: 4S, Scandinavian Simvastatin Survival Study • AFG, abnormal fasting glucose • CARE, Cholesterol and Recurrent Events trial • CHD, coronary heart disease • HMG, hydroxymethylglutaryl • HPS, Heart Protection Study • IFG, impaired fasting glucose • LIPID, Long-Term Intervention with Pravastatin in Ischemic Disease • NFG, normal fasting glucose • RRR, relative risk reduction • WOSCOPS, West of Scotland Coronary Prevention Study
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