Diabetes and lipid lowering: where are we?

Premature morbidity and mortality is substantially due to cardiovascular disease, with tobacco use, hypertension, and abnormal lipids being the main modifiable causal factors. Glycaemia is directly related to cardiovascular risk,1 and in people with diabetes the risk of cardiovascular disease approaches that in non-diabetic people with previous myocardial infarction.2 3

Because most people with type 2 diabetes have an absolute risk of cardiovascular disease of 20% or more over 10 years, guidelines suggest active intervention to reduce risk factors in patients with diabetes, including statin therapy to reduce the serum concentration of low density lipoprotein cholesterol (LDL-C) to < 2 mmol/l.3 In this week's BMJ Costa and colleagues report a meta-analysis of trials of lipid lowering drug therapy for primary and secondary coronary heart disease prevention in patients with and without diabetes.4

Review by the National Institute for Health and Clinical Excellence (NICE) of the role of statins in preventing cardiovascular disease has endorsed the routine use of statins in people with an absolute risk of 3 20% over 10 years as effective and cost effective …