*For medical professionals only
“img class=”responsive ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLibqE2uw/640″ width=”6400″ >Type 2 diabetes is the leading cause of death worldwide, and by 2025, it is expected to affect 380 million people worldwide with an increased risk of cardiovascular disease.
By reducing blood low-density lipoprotein cholesterol (LDL-C) levels, lipid-lowering treatments such as statins are considered primary and secondary prevention of cardiovascular disease. Foundation. Statins have been found to be the most effective drugs for reducing the risk of coronary heart disease in people with diabetes. The National Cholesterol Education Program recommends the use of LDL-C values to estimate cardiovascular disease risk associated with individual lipoproteins. However, non-high-density lipoprotein cholesterol (HDL-C) may be more associated with cardiovascular disease risk in patients receiving statins and may be a better tool than LDL-C to assess cardiovascular disease risk and treatment efficacy .
In April 2021, the UK National Institute for Health and Management Excellence (NICE) updated guidelines for the management of adults with diabetes. NICE currently recommends that non-HDL-C should replace LDL-C as the primary target for cardiovascular risk reduction through lipid-lowering therapy. In contrast, other international guidelines do not set non-HDL-C targets. The European Society of Cardiology has LDL-C as its therapeutic target. Likewise, the American College of Cardiology, American Heart Association, and National Lipid Association target LDL-C reduction based on a patient’s risk.
Although non-HDL-C has the potential to be a predictor of cardiovascular disease, no studies have evaluated the comparative effectiveness of different lipid-lowering treatments on non-HDL-C levels in diabetic patients.
Recently, the British Medical Journal (BMJ) published a systematic review and network meta-analysis evaluating the comparative efficacy of seven statins on non-HDL-C levels in diabetic patients . Let’s take a look together!
Study Design
Systematic review and network meta-analysis.
Data sources: Medline, Cochrane Central Register of Controlled Trials and Embase, from Beginning through December 1, 2021.
Methods of review: comparison included in adults with type 1 or type 2 diabetes , randomized controlled trials of different types and strengths of statins, including placebo.
Primary endpoint: Changes in non-HDL cholesterol levels, calculated from measurements of total cholesterol and high-density lipoprotein cholesterol.
Secondary endpoints: changes in low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels, major cardiovascular events (non-fatal stroke, non-fatal myocardial infarction) and cardiovascular disease-related deaths), and discontinuation due to adverse events.
Bayesian network meta-analysis with random effects for statin intensity (low, medium, or high), Treatment effects on non-HDL-C were assessed by mean differences and 95% confidence intervals. Subgroup analyses were performed between patients at greater risk for major cardiovascular events and those at low or intermediate risk.
A network meta-analysis (CINeMA) framework was applied to clarify the certainty of evidence.
Findings
In 42 randomized controlled trials involving 20,193 adults, 11,698 people were included in the meta-analysis.
Statin strength direct comparison table, effect estimated as mean difference (mmol/L) >
Compared to placebo, the greatest reduction in non-HDL-C levels was seen in the following situations:
Rosuvastatin:
High Strength: -2.31mmol/L, 95% confidence Interval [CI] -3.39 to -1.21
Moderate: -2.27mmol/L, 95%[CI] -3.00 to -1.49
Simvastatin
High Strength: -2.26mmol/L, 95% [CI ]-2.99 to -1.51)
atorvastatin
High strength: -2.20mmol/L, 95%[CI]-2.69 to -1.70
Atorvastatin, simvastatin, and low-intensity pravastatin of any strength are also effective in reducing non-HDL-C levels.
In 4670 patients at high risk of cardiovascular events,
high-intensity atorvastatin was effective against non-HDL -C levels had the greatest reduction
(-1.98mmol/L, 95%[CI] -4.16 to 0.26, 64% of the lower surface of the cumulative ranking curve).
Statins’ non-HDL-C reduction intensity (adjusted for patient risk) compared with Forest plot of network effect sizes compared to placebo.
High-intensity simvastatin and rosuvastatin are the most effective treatments for lowering LDL-C:
Simvastatin: -1.93mmol/L, 95%[CI] -2.63 to -1.21;
rosuvastatin: -1.76mmol/ L, 95% [CI] -2.37 to -1.15.
available to compare LDL-C lowering networks between
And forest plot of network effect size for statin intensity compared to placebo.
Moderate-intensity atorvastatin significantly reduced nonfatal myocardial infarction compared with placebo p>
(relative risk=0.57, confidence interval 0.43 to 0.76, n=4 studies).
No significant differences were found in drug discontinuation, non-fatal stroke, and cardiovascular death.
Conclusions
This network meta-analysis shows that moderate and high-intensity doses of Rosuvastatin, as well as high-intensity doses of simvastatin and atorvastatin, were most effective at modestly reducing non-HDL-C levels in people with diabetes.
Given that the accuracy of predicting cardiovascular disease may improve when reducing non-HDL-C levels is the primary goal, these findings suggest that reducing non-HDL-C levels in diabetic patients, Guidance is provided on how to choose the most effective statin type and strength.
Review Highlights
< span>In this systematic review and network meta-analysis, compared1type or 2Statins of different types and intensities in patients with type 2 diabetes.
A moderate and high-intensity dose of rosuvastatin was observed (-2.27 mmol/L and -2.31 mmol/L, respectively), and High-intensity doses of simvastatin (-2.26 mmol/L) and atorvastatin (-2.20 mmol/L) had the largest reductions in non-HDL-C.
High-intensity doses of atorvastatin are associated with maximal reductions in non-HDL-C in high-risk patients for major adverse cardiovascular events , while high-intensity doses of rosuvastatin and simvastatin were most effective in lowering LDL-C.
These data underscore that non-HDL-C should be prioritized in patients with diabetes when the primary therapeutic target for lipid and cardiovascular risk management is Which statin type and strength.
Source:
< span>Comparative effectiveness of statins on non-high density lipoprotein cholesterol in people with diabetes and at risk of cardiovascular disease: systematic review and network meta-analysis. BMJ. 2022;376:e067731. doi: 10.1136/bmj-2021-067731.
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