Statin duration may be crucial determinant of type 2 diabetes MACE risk
medwireNews: The duration of statin therapy in people with type 2 diabetes may be even more important than the intensity or the achieved level of low-density lipoprotein (LDL) cholesterol for preventing cardiovascular events, research suggests.
“The statin therapy duration – or adherence – should be considered as an important factor for estimating the cardioprotective effects of statins,” researcher Ji Yoon Kim (Korea University College of Medicine, Seoul) told attendees at the virtual ADA 81st Scientific Sessions.
In line with clinical trial results, the researchers also found that a higher statin intensity offered greater protection than a lower intensity.
Using data from a nationwide cohort of participants in South Korean health screening programs, the team identified 383 people with type 2 diabetes taking a low-intensity statin and matched them by propensity score to 8554 people given a moderate- or high-intensity statin.
During a median 41.9 months of follow-up, people receiving moderate- or high-intensity treatment were 28% less likely to have a major adverse cardiovascular event (MACE) than those given low-intensity treatment.
And within the group receiving moderate- or high-intensity statins, a lower achieved LDL cholesterol level was significantly associated with a lower MACE risk.
“Although recent trials strengthened the concept of ‘lower is better’ for LDL cholesterol, most of the trials included very high risk groups,” said Kim.
“Our study finds this concept would be applicable to type 2 diabetes patients with diverse cardiovascular risk.”
In addition, a longer duration of statin therapy was significantly associated with a reduced MACE risk, becoming statistically significant for durations of 18–24 months and longer.
Moreover, when the researchers calculated the relative importance of a range of MACE predictors, they found the duration of statin therapy explained a larger proportion of the likelihood of having a MACE than the achieved LDL cholesterol level or statin intensity.
Specifically, the duration of statin therapy was the fifth most important predictor, behind pre-existing ischemic heart disease, insulin use, sex, and pre-existing ischemic stroke. Achieved LDL cholesterol and statin intensity ranked seventh and 10th, respectively
“This is an important finding, considering that many patients discontinue statins in clinical practice,” said Kim.
She added: “We suppose that the continued use of statins is critical in reducing exposure to apolipoprotein-B–containing lipoproteins, which increases an individual’s total atherosclerotic plaque burden.”
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