Statins Found to Help Diabetics

Cholesterol-lowering drugs called statins can reduce the incidence of heart attacks and strokes among diabetics by a quarter to a third, even in patients who do not have high cholesterol levels, according to a major new British study.

Giving the drugs to the 17 million Americans with diabetes could prevent as many as 170,000 heart attacks and strokes each year, researchers said. Worldwide, the drugs could prevent more than 1 million such events each year, they added.

Physicians should “now ask whether all type 2 diabetics should be given a statin, regardless of their cholesterol value,” said Dr. Lars H. Lindholm of the Umea University Hospital in Sweden, who wrote a commentary accompanying the report in today’s issue of the Lancet.

The American Diabetes Assn. has already begun considering such a revision in its treatment guidelines, although it may be some time before a change is made, said Dr. Nathaniel Clark, the group’s vice president for clinical affairs.

Clark noted that many studies have already shown the value of statins for treating people at high risk of heart disease, and thought had been given to changing the guidelines. “But now that we have diabetes-specific data, we have a more compelling reason to look seriously at what the guidelines should be,” he said.

Cardiovascular disease is a major problem among diabetics, both the estimated 1 million type 1 diabetics who require regular insulin injections and the 16 million type 2 diabetics who can often manage their insulin levels with drugs. Two out of every three diabetics die of heart disease or stroke -- twice the proportion in the population at large.

Statins, which include such drugs as Zocor, Mevacor, Pravachol, Lescol and Lipitor, reduce cholesterol levels by blocking the body’s synthesis of fats. They have proved remarkably effective in reducing heart attacks and cardiovascular disease in high-risk patients, even those without high cholesterol levels. About 25 million people worldwide already take them.

The new study of diabetics is actually part of a much larger study, published last year, which suggested that statins should be used more frequently in all high-risk patients. Today’s report focuses on the approximately 6,000 patients in that study with diabetes. Half of the patients already had some degree of heart disease at the beginning of the study.

Half of the patients were given 40 milligrams of Zocor -- known generically as simvastatin -- every day for five years, while the rest received a placebo.

Overall, about 25% of the patients who received a placebo had at least one heart attack, stroke or revascularization procedure (angioplasty or bypass) over the five years of the study. Those who received simvastatin had at least a quarter fewer events and, in some groups, as many as a third fewer. The results were the same regardless of the patient’s age, sex or cholesterol level, according to Dr. Rory Collins of the University of Oxford, who led the study.

Dr. Jane Armitage of Oxford, the clinical coordinator of the study, said: “Five years of treatment in diabetic patients without

Collins also noted that patents are beginning to expire on many of the statins, so that “these drugs are becoming much cheaper and will be affordable in many more countries around the world.”

The study was sponsored by the U.K. Medical Research Council, the British Heart Foundation and Merck & Co., which manufactures Zocor.