Major benefits from cholesterol-lowering in patients with diabetes

Two other recent randomised statin trials involving large numbers of patients with type 2 diabetes did not show any significant difference when active therapy was compared with either usual care or placebo treatment. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial... Full description

Two other recent randomised statin trials involving large numbers of patients with type 2 diabetes did not show any significant difference when active therapy was compared with either usual care or placebo treatment. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT),1 40 mg pravastatin daily was compared with usual care in more than 10 000 hypertensive patients (mean age 66 years). About 3600 had type 2 diabetes at randomisation. Mainly due to the use of non-study statin therapy in the usual-care group, the average difference in LDL-cholesterol concentration between these two treatment groups was only about 0[middot]6 mmol/L during 4[middot]8 years' follow-up, and there was no significant difference in the all-cause mortality or coronary event rates, with or without the presence of type 2 diabetes at baseline. In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-LLA),2 10 mg atorvastatin daily was compared with placebo in more than 10 000 hypertensive patients (mean age 63 years), of whom about 2500 had type 2 diabetes at entry. The average difference in LDL-cholesterol concentration between the groups was about 1[middot]1 mmol/L during 3[middot]3 years' follow-up. In the patients with diabetes, there was no significant difference (p=0[middot]43) between the incidence of primary events (non-fatal myocardial infarction and fatal coronary heart disease)-3[middot]0% atorvastatin compared with 3[middot]6% placebo.