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Lowering LDL-cholesterol reduces CV event risk in diabetic dyslipidaemia

Cardiovascular – October 2019 digest

LDL-cholesterol lowering reduces atherosclerotic cardiovascular disease event risk in statin-treated patients with type 2 diabetes and dyslipidaemia.

Rana JS, Liu JY, Moffett HH et al (2019) Risk of cardiovascular events in patients with type 2 diabetes and metabolic dyslipidemia without prevalent atherosclerotic cardiovascular disease. Am J Med Jul 22, 2019 [epub ahead of print] 

  • Patients with type 2 diabetes and dyslipidaemia are at high risk for atherosclerotic cardiovascular disease events. Statins are the mainstay of risk reduction but questions remain about the association between low-density lipoprotein (LDL) cholesterol levels and risk of incident atherosclerotic cardiovascular disease in this group of patients.
  • Investigators conducted an observational cohort study of 19,095 patients with type 2 diabetes, metabolic dyslipidaemia and high LDL-cholesterol who were taking stains but who did not have atherosclerotic cardiovascular disease. 
  • Patients (mean age 63.4 years) were followed up for 5.9 years and the rates of atherosclerotic cardiovascular disease stratified according to LDL-cholesterol categories.
  • The level of LDL-cholesterol achieved had no significant effect on unadjusted rates of atherosclerotic cardiovascular disease events. 
  • After adjusting for demographics and clinical characteristics, there was significantly lower risk of incident atherosclerotic cardiovascular disease events with decreasing LDL-cholesterol levels (P<0.0001). Individuals achieving LDL-cholesterol <50 mg/dl had the lowest level of risk.
  • It was concluded that lower LDL-cholesterol levels were associated with a lower risk of incident atherosclerotic cardiovascular disease events in statin-treated patients with type 2 diabetes and dyslipidaemia and that further evaluation of the benefits of achieving very low LDL-cholesterol in these patients was needed.

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