Skip to main content

Statin Therapy: Impact on Dyslipidemia and Cardiovascular Events in Patients with Diabetes

  • Chapter
  • First Online:
Lipoproteins in Diabetes Mellitus

Part of the book series: Contemporary Diabetes ((CDI))

  • 388 Accesses

Abstract

Diabetes mellitus is associated with high rates of atherosclerosis-related cardiovascular events. Rigorous randomized controlled trials have shown consistently beneficial effects with statin treatment in patients with diabetes mellitus, reducing event rates. The beneficial effects are seen consistently with low-density lipoprotein cholesterol lowering. In the summary meta-analysis of statin therapy trials by the Cholesterol Treatment Trialists’ Collaboration, every approximate 40 mg/dL (1.0 mmol/L) reduction in LDL-C yields a relative risk reduction of major vascular events of ~20–25%. Further reduction of risk may be achieved with more aggressive combination statin and non-statin therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Skalen K, Gustafsson M, Rydberg EK, Hulten LM, Wiklund O, Innerarity TL, et al. Subendothelial retention of atherogenic lipoproteins in early atherosclerosis. Nature. 2002;417(6890):750–4.

    Article  CAS  PubMed  Google Scholar 

  2. Tabas I, Williams KJ, Boren J. Subendothelial lipoprotein retention as the initiating process in atherosclerosis: update and therapeutic implications. Circulation. 2007;116(16):1832–44.

    Article  CAS  PubMed  Google Scholar 

  3. Fruchart JC, Sacks F, Hermans MP, Assmann G, Brown WV, Ceska R, et al. The residual risk reduction initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia. Am J Cardiol. 2008;102(10 Suppl):1K–34K.

    Article  PubMed  Google Scholar 

  4. Martin SS, Blaha MJ, Elshazly MB, Brinton EA, Toth PP, McEvoy JW, et al. Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. J Am Coll Cardiol. 2013;62(8):732–9.

    Article  CAS  PubMed  Google Scholar 

  5. Sniderman A, Williams K, de Graaf J. Non-HDL C equals apolipoprotein B: except when it does not! Curr Opin Lipidol. 2010;21(6):518–24.

    Article  CAS  PubMed  Google Scholar 

  6. Kastelein JJ, van der Steeg WA, Holme I, Gaffney M, Cater NB, Barter P, et al. Lipids, apolipoproteins, and their ratios in relation to cardiovascular events with statin treatment. Circulation. 2008;117(23):3002–9.

    Article  CAS  PubMed  Google Scholar 

  7. Sniderman A, Solhpour A. Targeting targets for LDL-lowering therapy: lessons from the Collaborative Atorvastatin Diabetes Study (CARDS). Clin Chem. 2009;55(3):391–3.

    Article  CAS  PubMed  Google Scholar 

  8. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360(9326):7–22.

    Article  Google Scholar 

  9. Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003;361(9374):2005–16.

    Article  PubMed  Google Scholar 

  10. Sever PS, Dahlof B, Poulter NR, Wedel H, Beevers G, Caulfield M, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003;361(9364):1149–58.

    Article  CAS  PubMed  Google Scholar 

  11. Sever PS, Poulter NR, Dahlof B, Wedel H, Collins R, Beevers G, et al. Reduction in cardiovascular events with atorvastatin in 2,532 patients with type 2 diabetes: Anglo-Scandinavian Cardiac Outcomes Trial–Lipid-Lowering Arm (ASCOT-LLA). Diabetes Care. 2005;28(5):1151–7.

    Article  CAS  PubMed  Google Scholar 

  12. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the collaborative atorvastatin diabetes study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685–96.

    Article  CAS  PubMed  Google Scholar 

  13. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002;288(23):2998–3007.

    Article  Google Scholar 

  14. Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371(9607):117–25.

    Article  CAS  PubMed  Google Scholar 

  15. Sattar N, Preiss D, Murray HM, Welsh P, Buckley BM, de Craen AJ, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375:735–42.

    Article  CAS  PubMed  Google Scholar 

  16. Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195–207.

    Article  CAS  PubMed  Google Scholar 

  17. Graham DJ, Staffa JA, Shatin D, Andrade SE, Schech SD, La Grenade L, et al. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA. 2004;292(21):2585–90.

    Article  CAS  PubMed  Google Scholar 

  18. Newman CB, Preiss D, Tobert JA, et al. Statin safety and associated adverse events: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2019;39(2):e38–81.

    Article  CAS  PubMed  Google Scholar 

  19. Michos ED, Martin SS. Achievement of very low low-density lipoprotein cholesterol levels: is it time to unlearn concern for hemorrhagic stroke? Circulation. 2019;140(25):2063–6.

    Article  CAS  PubMed  Google Scholar 

  20. Hammad MA, Syed Sulaiman SA, Aziz NA, Mohamed Noor DA. Evaluation of statins impacts on cognitive function among diabetic patients. Diabetes Metab Syndr. 2019;13(3):1797–803.

    Article  PubMed  Google Scholar 

  21. Ridker PM, MacFadyen JG, Fonseca FA, Genest J, Gotto AM, Kastelein JJ, et al. Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER). Circ Cardiovasc Qual Outcomes. 2009;2(6):616–23.

    Article  PubMed  Google Scholar 

  22. Mihaylova B, Briggs A, Armitage J, Parish S, Gray A, Collins R. Lifetime cost effectiveness of simvastatin in a range of risk groups and age groups derived from a randomised trial of 20,536 people. BMJ. 2006;333(7579):1145.

    Article  PubMed  Google Scholar 

  23. Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358(6):580–91.

    Article  CAS  PubMed  Google Scholar 

  24. Akhabue E, Rittner SS, Carroll JE, et al. Implications of American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines on statin underutilization for prevention of cardiovascular disease in diabetes mellitus among several US Networks of Community Health Centers. J Am Heart Assoc. 2017;6(7):e005627.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kovarnik T, Chen Z, Mintz GS, et al. Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology. Cardiovasc Diabetol. 2017;16(1):156.

    Article  PubMed  PubMed Central  Google Scholar 

  26. de Graaf J, Couture P, Sniderman A. A diagnostic algorithm for the atherogenic apolipoprotein B dyslipoproteinemias. Nat Clin Pract Endocrinol Metab. 2008;4(11):608–18.

    Article  PubMed  Google Scholar 

  27. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110(2):227–39.

    Article  PubMed  Google Scholar 

  28. Otvos JD, Mora S, Shalaurova I, Greenland P, Mackey RH, Goff DC Jr. Clinical implications of discordance between low-density lipoprotein cholesterol and particle number. J Clin Lipidol. 2011;5(2):105–13.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sniderman AD, Williams K, Contois JH, Monroe HM, McQueen MJ, de Graaf J, et al. A meta-analysis of low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and apolipoprotein B as markers of cardiovascular risk. Circ Cardiovasc Qual Outcomes. 2011;4(3):337–45.

    Article  PubMed  Google Scholar 

  30. Rana JS, Liu JY, Moffet HH, Sanchez RJ, Khan I, Karter AJ. Risk of cardiovascular events in patients with type 2 diabetes and metabolic dyslipidemia without prevalent atherosclerotic cardiovascular disease. Am J Med. 2020;133(2):200–6.

    Article  CAS  PubMed  Google Scholar 

  31. Sarkar S, Orimoloye OA, Nass CM, Blumenthal RS, Martin SS. Cardiovascular risk heterogeneity in adults with diabetes: selective use of coronary artery calcium in statin use decision-making. J Gen Intern Med. 2019;34(11):2643–7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Zhang W, Luan Y, Jin C, et al. The impact of rosuvastatin on the density score of coronary artery calcification in coronary artery disease patients with type 2 diabetes mellitus: rationale and design of RosCal Study. Clin Drug Investig. 2016;36(12):1023–9.

    Article  PubMed  Google Scholar 

  33. Gotto AM Jr, Whitney E, Stein EA, Shapiro DR, Clearfield M, Weis S, et al. Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Circulation. 2000;101(5):477–84.

    Article  CAS  PubMed  Google Scholar 

  34. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082–143.

    PubMed  Google Scholar 

  35. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255–323.

    Article  PubMed  Google Scholar 

  36. American Diabetes Association. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes - 2021. Diabetes Care. 2021;44(Suppl 1):S125–50.

    Article  Google Scholar 

  37. Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017;23(Suppl 2):1–87.

    Article  PubMed  Google Scholar 

  38. Le NA, Tomassini JE, Tershakovec AM, Neff DR, Wilson PW. Effect of switching from statin monotherapy to ezetimibe/simvastatin combination therapy compared with other intensified lipid-lowering strategies on lipoprotein subclasses in diabetic patients with symptomatic cardiovascular disease. J Am Heart Assoc. 2015;4(10):e001675.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372(25):2387–97.

    Article  CAS  PubMed  Google Scholar 

  40. Lee YH, Hong N, Lee CJ, et al. Differential association of ezetimibe-simvastatin combination with major adverse cardiovascular events in patients with or without diabetes: a retrospective propensity score-matched cohort study. Sci Rep. 2018;8(1):11925.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Tell S, Nadeau KJ, Eckel RH. Lipid management for cardiovascular risk reduction in type 1 diabetes. Curr Opin Endocrinol Diabetes Obes. 2020;27(4):207–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017;376(18):1713–22.

    Article  CAS  PubMed  Google Scholar 

  43. Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med. 2018;379(22):2097–107.

    Article  CAS  PubMed  Google Scholar 

  44. Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11–22.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Seth S. Martin .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gudenkauf, B.M., Jones, S.R., Martin, S.S. (2023). Statin Therapy: Impact on Dyslipidemia and Cardiovascular Events in Patients with Diabetes. In: Jenkins, A.J., Toth, P.P. (eds) Lipoproteins in Diabetes Mellitus. Contemporary Diabetes. Humana, Cham. https://doi.org/10.1007/978-3-031-26681-2_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-26681-2_22

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-031-26680-5

  • Online ISBN: 978-3-031-26681-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics