People with Type 2 Diabetes who “don’t need” statins get significant benefit from intensive lipid lowering
Results of AFORRD trial presented at International Diabetes Federation World Diabetes Congress (IDF), Cape Town, South Africa
Results from a UK study by Oxford University have shown that patients not considered by their physicians to be at high enough risk for statin therapy benefit significantly from the intensive lipid lowering, as recommended by the latest cardiovascular disease (CVD) guidelines.
AFORRD (Atorvastatin in Factorial with Omega-3 fatty acids Risk Reduction in Diabetes) was a real world primary care study of 800 people with type 2 diabetes which aimed to assess the degree to which a statin and/or omega-3 fatty acids affect the lipid profile and the estimated risk of CVD. Despite recruiting patients not considered to be at high enough CVD risk to warrant statin treatment by their GP, it was found that 74% of the population were actually at high estimated CVD risk (>20% over 10 years), and 94% were at moderate to high risk (>10% over 10 years).
In these patients, lipid lowering with atorvastatin 20mg (trade name Lipitor) reduced LDL-cholesterol to ≤2.6mmol/l in 91% of patients (mean 1.8mmol/l) and significantly reduced the estimated 10 year CVD risk by 22% (absolute risk reduction 6.7%).
“The study shows that the majority of people with type 2 diabetes in primary care are at higher cardiovascular risk than previously thought,” commented Professor Andrew Neil, Co-Principal Investigator of the study. “The new guidelines from the Joint British Societies recommend statin treatment for the majority of people with type 2 diabetes, treating to a LDL-cholesterol target of 2mmol/l. However, this advice was based on outcomes trials which recruited patients mainly in secondary care and who were at enhanced CVD risk. AFORRD shows that intensive lipid lowering for most people with diabetes is the right approach for primary care too.”
Professor Rury Holman, Co-Principal Investigator added: “Although statin treatment is important, for many patients lipid lowering therapy alone may not reduce their CVD risk sufficiently, and additional risk reduction strategies still need to be considered.”
AFORRD also examined whether a pharmaceutical preparation of highly-purified fish oil (Omega-3 EE90, trade name Omacor) reduced blood triglyceride levels. High triglycerides are thought to increase the risk of CVD. In the study, omega-3 EE90 reduced the level of triglycerides in the blood by 5.6 per cent but there was no reduction in estimated CVD risk. However, the researchers point out that fish oils may reduce CVD risk in others ways, and further work is needed to find out more about their potential benefits.
Full results of the AFORRD study will be published next year.
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University of Oxford