The results of a large meta-analysis of 14 randomized trials on statins in 18,686 patients with diabetes were recently published in the Lancet. During a mean follow-up of 4.3 years, 3,247 major vascular events were reported. In patients with diabetes, there was a 9% reduction (13% in patients without diabetes) in all-cause mortality and a 21% reduction in vascular events per mmol/L of LDL cholesterol. There was no difference in the reduction in vascular events in patients with and without diabetes. After 5 years, 42 (95% CI, 30-55) fewer patients with diabetes had major vascular events per 1,000 patients who underwent statin therapy. The authors concluded that present guidelines need to be revised in order to potentially implement statin therapy in patients with diabetes and elevated LDL cholesterol levels. This paper was accompanied by an editorial by Bernard M Y Cheung who found the results of the meta-analysis “reassuring” and supported the authors’ conclusion that future guidelines should take into consideration these results. Cheung also emphasized that apart from pharmacotherapy, lifestyle changes such as smoking cessation, healthy diet, and physical activity also need to be considered.
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