Review

Reassessing the Benefits of Statins in the Prevention of Cardiovascular Disease in Diabetic Patients - A Systematic Review and Meta-Analysis

Yu-Hung Chang^1,2, Ming-Chia Hsieh^2,3, Cheng-Yuan Wang⁴, Kun-Cheng Lin¹, Yau-Jiunn Lee¹

Manuscript submitted February 9, 2013; resubmitted April 6, 2013; accepted April 30, 2013.

Keywords: cardiovascular disease, meta-analysis, dyslipidemia, LDL, lipoprotein, statin, type 2 diabetes, triglyceride

Abstract

OBJECTIVES: Despite the fact that statins have been prescribed widely, cardiovascular disease (CVD) remains the leading cause of death in diabetic patients. The aim of this study was to reassess the benefits of statins for CVD prevention in patients with diabetes mellitus. METHODS: Two independent investigators searched for prospective, randomized statin trials that investigated the power of reducing CVD in statin-treated patients. The search was performed using Pubmed, Web of Science, and CENTRAL databases. Data was extracted from eligible studies. RESULTS: A total of 7061 articles were surveyed and 22 articles were identified as eligible articles. The meta-analyses of the 22 trials showed that statin treatment was positively associated with a lowered risk of CVD in the following groups: (i) total population with pooled odds ratios (OR) of 0.791 (95 % CI: 0.74-0.846, p < 0.001), (ii) diabetic population with OR 0.792 (95% CI: 0.721-0.872, p < 0.001), and (iii) non-diabetic population with OR 0.791 (95% CI: 0.730-0.857, p < 0.001). In diabetic patients, statins were also helpful in the primary and secondary prevention of CVD, with pooled ORs of 0.757 (95% CI: 0.676 to 0.847, p < 0.001) and 0.800 (95% CI: 0.712 to 0.898, p < 0.001), respectively. However, when trials that investigated only diabetic patients (i.e., CARDS, 4D, and ASPEN) were included in the analysis, statin treatment was not found to reduce CVD significantly (OR: 0.817, 95% CI: 0.649 to 1.029, p = 0.086). Furthermore, after performing subgroup analysis, no benefit of statin treatment was found in primary prevention (OR: 0.774, 95% CI: 0.506 to 1.186, p = 0.240) or secondary prevention (OR: 0.893, 95% CI: 0.734 to 1.088, p = 0.262) of CVD in diabetic patients. CONCLUSIONS: Although our study may be limited by unmeasured confounders and heterogeneity among the studies included, the results suggest that the effects of statins in the prevention of CVD in diabetic patients are not only beneficial. More informative data are needed to verify the benefits of statins in the protection against CVD in diabetic patients.

Fulltext: HTML , PDF (630KB)

This article has been cited by other articles:

	Are diabetes guidelines truly evidence based? Bouchonville MF, Matani S, DuBroff JJ, DuBroff RJ Diabetes Res Clin Pract 2017. 127:70-79
	Exploring the Management of Statin Intolerant Patients: 2016 and Beyond Katsiki N, Athyros VG, Karagiannis A Curr Vasc Pharmacol 2016. 14(6):523-533
	The effect of the Conversation Map program in patients with poor glycemic control with type 2 diabetes mellitus-when usual care is not enough Shih YT, Hsu HC, Chen SY, Hsieh CH, Wang RH, Lee YJ, Chang YH Int J Clin Exp Med 2016. 9(2):3473-3480
	All for Statins and Statins for All; an Update Agouridis AP, Elisaf MS, Nair DR, Mikhailidis DP Curr Pharm Des 2016. 22(1):18-27
	Chromium supplementation in patients with type 2 diabetes and high risk of type 2 diabetes: a meta-analysis of randomized controlled trials San Mauro-Martin I, Ruiz-Leon AM, Camina-Martin MA, Garicano-Vilar E, Collado-Yurrita L, Mateo-Silleras BD, Redondo Del Rio Mde P Nutr Hosp 2016. 33(1):27
	Genomic approach to cardiovascular disease San Mauro-Martin I, de la Calle-de la Rosa L, Sanz-Rojo S, Garicano-Vilar E, Ciudad-Cabanas MJ, Collado-Yurrita L Nutr Hosp 2016. 33(1):12
	Statins and their increased risk of inducing diabetes Agouridis AP, Kostapanos MS, Elisaf MS Expert Opin Drug Saf 2015. 14(12):1835-144
	A meta-analysis of the effects of statin treatment on cardiovascular events and all-cause mortality in diabetic dialysis patients Yang M, Xie XS, Yuan WJ Int J Clin Exp Med 2015. 8(6):8415-8424
	The influence of strength training and fish oil supplementation on blood parameters in elderly women de Lourdes Nahhas Rodacki C, Rodacki AL, Coelho I, Pequito D, Krause M, Bonatto S, Naliwaiko K, Fernandes LC Rev Educ Fis 2015. 26(3):413-423
	Influence of fish oil supplementation and strength training on some functional aspects of immune cells in healthy elderly women de Lourdes Nahhas Rodacki C, Rodacki AL, Coelho I, Pequito D, Krause M, Bonatto S, Naliwaiko K, Fernandes LC Br J Nutr 2015. 114(1):43-52
	Statins' Cardiovascular Benefits Outweigh their Diabetogenicity: A Direct Comparison between Number Needed to Treat and Number Needed to Harm Shimoyama S Adv Pharmacoepidemiol Drug Saf 2015. 4:4
	Beyond confusion and controversy, can we evaluate the real efficacy and safety of cholesterol-lowering with statins? de Lorgeril M, Rabaeus M J Controv Biomed Res 2015. 1(1):67-92
	Efficacy of standard and intensive statin treatment for the secondary prevention of cardiovascular and cerebrovascular events in diabetes patients: a meta-analysis de Vries FM, Kolthof J, Postma MJ, Denig P, Hak E Plos One 2014. 9(11):e111247