Review Questions Cholesterol Guidelines For Diabetics

| September 13, 2012

There have been news reports out recently in the UK regarding the ‘need’ for diabetics to manage their cholesterol levels properly. Calls of this nature have come from Baroness Barbara Young, chief executive of the charity Diabetes UK, the UK’s largest and most prominent diabetes charity. I read in a story on the BBC website that Baroness Young claims: “It will often be appropriate to prescribe medication such as statins, but it is no good doing this without explaining the importance of taking the medication regularly and the potentially devastating consequences of not doing so.”

To be honest, I have grown used to this sort of rhetoric from those of some prominence in the health arena, but I’ve also learned that it is rarely a good idea to take such rhetoric at face value. I thought I would see whether the idea that management of cholesterol in diabetics is based on good evidence. I came across a pertinent review of this subject published earlier this year.

The authors of this review assessed studies in which cholesterol-lowering drugs were used to treat individuals with diabetes. They excluded studies which had been terminated early for no good reason (early termination of studies has the capacity to exaggerate the benefits and reduce the apparent harms of a treatment), as well as studies which were not properly conducted in that participants were not properly ‘randomized’ (this can mean the underlying characteristics of those taking the medication are not the same as those taking the placebo, which in turn can give misleading results).

After making these exclusions, four trials were left: three in which a statin was the drug being tested and one which tested the effects of a fibrate (another type of cholesterol-lowering drug).

Here’s a brief summary of the results of each of these four studies.

1. Study: A reduction in risk of major cardiovascular events (e.g. heart attack or stroke) of 37 per cent. Overall risk of death was not reduced.

2. Study: No reduced risk of a ‘composite endpoint’ encompassing a variety of outcomes including cardiovascular death (death due to heart attack or stroke), and non-fatal heart attacks and strokes. Again, the overall risk of death was not reduced.

3. Study: No reduced risk of a composite endpoint made up of cardiovascular death as well as non-fatal heart attacks and strokes. No reduced risk of death overall.

4. Study: No reduced risk of fatal and non-fatal heart attacks. No reduced risk of death overall.

The authors of the review conclude: “This review does not support the use of cholesterol-lowering drugs (such as statin and fibrate) to reduce mortality and cardiovascular complications in type 2 diabetics.”

The authors suggest that the guidelines regarding cholesterol management in diabetics have been corrupted somewhat by the conflicts of interest some advisors have, by remarking: “Official guidelines should be re-examined and reformulated by experts independent from the pharmaceutical industry.”

This review, which takes a relatively objective look at this evidence, asks questions again about the effectiveness of cholesterol-reducing strategies. And it also asks questions of reliability of recommendations that come from individuals whose advice may be biased because of their conflicts of interest.

 

Here’s to a healthy heart

Dr John Briffa
Editor
for The Cholesterol Truth



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Bear in mind we are not addressing anyone’s personal situation and you should rely on this for informational purposes only. Please consult with your own physician before acting on any recommendations contained herein.


References:

1. de Lorgeril M, et al. Is the use of cholesterol-lowering drugs for the prevention of cardiovascular complications in type 2 diabetics evidence-based? A systematic review. Rev Recent Clin Trials 2012;7(2):150-7

2. Colhoun HM, et al; CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685-96

3. Knopp RH, et al. Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes: the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in non-insulin-dependent diabetes mellitus (ASPEN). Diabetes Care. 2006;29(7):1478-85

4. Wanner C, et al, for the German Diabetes and Dialysis Study Group. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005; 353:238-248

5. Keech A, et al; FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005 Nov 26;366(9500):1849-61

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