Lipid-lowering trials in diabetes
Diabetes mellitus is increasing in prevalence and incidence and is estimated to affect over 100 million people worldwide. Cardiovascular disease accounts for some 60% of deaths among people with diabetes as well as substantial morbidity. The extent to which cardiovascular complications can be modified by risk factor intervention is of major importance. This review examines the data from observational studies on the relationship between coronary heart disease risk and cholesterol levels in those with and without diabetes and looks at the relevant evidence from completed large scale randomized trials as well the implications of ongoing and planned studies. Observational data show a graded association between risk of CHD and cholesterol in those with and without diabetes. Randomized trials have shown that lipid-lowering using statins is beneficial in certain high-risk groups who are being increasingly targeted for therapy. Relatively few individuals with diabetes have been included in completed trials but the available data show similar effects in those with diabetes as without. Large scale ongoing trials and a planned systematic overview of the cholesterol intervention trials should provide substantially more evidence about the role of lipid lowering for the wide range of people with diabetes.