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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews.

Pharmacologic lipid-lowering therapy in type 2 diabetes mellitus: background paper for the American College of Physicians

Review published: 2004.

Bibliographic details: Vijan S, Hayward R A.  Pharmacologic lipid-lowering therapy in type 2 diabetes mellitus: background paper for the American College of Physicians. Annals of Internal Medicine 2004; 140(8): 650-658. [PubMed: 15096337]

Quality assessment

This review assessed the effectiveness of pharmacologic lipid-lowering therapy in preventing cardiovascular events in patients with type 2 diabetes. Lipid-lowering agents were found to reduce cardiovascular risk. However, the authors warned that recommendations for primary prevention therapy could not be made for diabetics with relatively low cardiovascular risk. The evidence was not assessed for quality, hence the conclusions may not be reliable. Full critical summary


BACKGROUND: Cardiovascular disease is the primary complication and cause of death in patients with type 2 diabetes mellitus. Modification of cardiovascular risk factors may improve patient outcomes.

PURPOSE: To evaluate the effectiveness of pharmacologic lipid-lowering therapy on outcomes in type 2 diabetes mellitus.

DATA SOURCES: Review of the literature.

STUDY SELECTION: Randomized trials evaluating clinical outcomes of lipid-lowering treatment in patients with diabetes.

DATA EXTRACTION: Studies were identified by searching the Cochrane Library, MEDLINE, meta-analyses, review articles, and inquiries to experts. The Cochrane Library and MEDLINE searches were done in September 2002. Data were abstracted onto standardized forms by a single reviewer and were confirmed by a second reviewer.

DATA SYNTHESIS: Meta-analysis of 6 primary prevention studies showed that lipid-lowering medications reduced risks for cardiovascular outcomes (relative risk, 0.78 [95% CI, 0.67 to 0.89]; absolute risk reduction, 0.03 [CI, 0.01 to 0.04] in 4.3 years of treatment); 1 major cardiovascular event was prevented by treating 34 to 35 patients. Meta-analysis of 8 studies of secondary prevention showed a similar relative risk (0.76 [CI, 0.59 to 0.93]) but more than twice the absolute risk reduction (0.07 [CI, 0.03 to 0.12] in 4.9 years of treatment) and a number needed to treat for benefit of 13 to 14. Most studies compared a lipid-lowering drug with placebo but did not evaluate the effect of reaching specific cholesterol levels. The benefit of lipid lowering with a fixed dose of a statin appeared to be similar regardless of starting cholesterol levels.

LIMITATIONS: Target cholesterol levels and the effectiveness of dose titration (or the use of multiple agents) have not been rigorously examined.

CONCLUSIONS: In patients with type 2 diabetes, treatment with lipid-lowering agents reduces cardiovascular risk. Most patients, including those whose baseline low-density lipoprotein cholesterol levels are below 2.97 mmol/L (<115 mg/dL), and possibly below 2.59 mmol/L (<100 mg/dL), benefit from statins. Moderate doses of these drugs suffice in most patients with diabetes.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2012 University of York.

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