Update in General Internal Medicine

Cardiovascular Disease and Statin Use

This year's trial results indicate a real change in our understanding of indications for the use of statins. In type 2 diabetic patients with at least 1 additional risk factor for coronary heart disease, lipid-lowering treatment with statins is effective for primary prevention of cardiovascular disease (CVD). In patients with acute coronary syndromes, early initiation of intensive lipid-lowering treatment to achieve serum low-density lipoprotein (LDL) cholesterol levels below 1.80 mmol/L (<70 mg/dL) prevents major cardiovascular events more effectively than moderate lipid lowering. Intensive lipid lowering is also beneficial for patients with stable coronary disease. These results indicate that statin treatment could benefit a greater number of patients and that target LDL cholesterol levels for treatment of patients at highest risk should be lower than previously recommended. Because these findings indicate that patients are now more likely to be using statins for many years, we are reassured to learn that treatment for as long as 10 years appears to be safe.

Statins Prevented Cardiovascular Events in High-Risk Patients with Type 2 Diabetes

This randomized, double-blind, placebo-controlled trial from the United Kingdom and Ireland assessed the effectiveness of atorvastatin for primary prevention of major cardiovascular events in patients with type 2 diabetes and normal serum LDL cholesterol levels. The trial involved 2838 adults (32% women; 94% white) 40 to 75 years of age (mean age, 62 years) with type 2 diabetes mellitus and at least 1 additional CVD risk factor: hypertension (84%), current cigarette use (22%), albuminuria (17%), or retinopathy (30%). The investigators assigned patients to …