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Defeat Diabetes
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Statins for All Diabetic Patients Justified

Posted: Thursday, September 27, 2007

A strategy of treating all diabetic men older than 40 years and all diabetic women older than 45 years with statins would be effective and efficient in reducing cardiovascular disease (CVD) events. 

 "Strategies for initiating statin use among adult patients with diabetes for primary cardiovascular disease prevention include treating all patients (assuming diabetes is a coronary risk equivalent) or treating patients who are at risk of developing CVD," write Dr. Iskandar Idris, of Sherwood Forest Hospitals Foundation Trust, Nottinghamshire, UK, and colleagues.

The researchers sought to combine both strategies to determine an appropriate age cutoff for prescribing statins to patients with diabetes, using data from a cross-sectional primary-care population study.

Their analyses included 60,258 patients with diabetes, of whom 11,005 men and women between the ages of 30 and 74 years met the criteria for primary CVD prevention. "Model outcomes were extrapolated to an estimated national diabetes prevalence of 3.6%," the team explains.

The investigators considered four strategies to reduce CVD events by starting statin therapy in diabetic patients:

- A population health strategy, treating all patients with diabetes

- A baseline risk strategy, treating patients with moderate or high baseline CVD risk.

- An individual risk factor strategy, treating patients whose cholesterol is greater than 5 mmol/L.

- An age cutoff strategy, by treating patients above an appropriate sex-specific age determined from combining the population health and baseline risk strategies.

The transition from low to moderate/high baseline risk of developing CVD occurred around ages 40.6 and 44.2 years for men and women, respectively. Using these age cut-offs, the sensitivity and specificity for identifying cardiovascular risk warranting statin therapy were 92.2% and 84.4% for men, 90.3% and of 81.3% for women.

The age cutoff strategy was effective and efficient when applied to the national population, Dr. Idris and associates report, with 11,094 events potentially avoided and a number-needed-to-treat of 25.1 to avert 1 event.

 
The least effective strategies were those of treating if cholesterol is greater than 5 mmol/L or if baseline risk is high.
"From this study, we advocate that in the absence of a specific indication for statin therapy (e.g., microalbuminuria, strong family or personal history of CVD risk, etc.), statins should still be routinely prescribed to all men and women with diabetes aged over 40 and 45 years, respectively, for primary CVD prevention," Dr. Idris and colleagues conclude. "This strategy is highly effective and efficient to prevent CVD events from a public health perspective."

Source: Diabetes In Control: Diabetes Care 2007;30:2025-2029

 
 
 
 
 
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