title: Association of a reduction in low-density lipoprotein cholesterol with incident cardiovascular and cerebrovascular events among people with type 2 diabetes mellitus.
abstract: BACKGROUND
  Although there is overwhelming evidence that reducing low-density lipoprotein cholesterol (LDL-C) with statins leads to reductions in cardiovascular disease, less is known about the effects in persons with type 2 diabetes mellitus (T2DM) without pre-existing vascular events.
  
  
  RESULTS
  Using the UK-based General Practice Research Database we conducted a retrospective cohort study of 21,998 T2DM patients aged 35-69 with ≥2 prescriptions for lipid-modifying therapy (2000-2009). We categorized LDL-C change (mmol/l) between last available and baseline lipid values as reduction (≥3.0, 2.0-2.9, 1.0-1.9, 0.3-0.9), no-change (±0.2 of baseline), or increase (>0.2). Outcomes were incident composite cardiovascular (n = 621) and cerebrovascular events (n = 274). We estimated hazard ratios (HRs) of study outcomes and 95% confidence intervals (CIs) for LDL-C change compared with the no-change group. Compared to no changes, adjusted HRs of cardiovascular events for a reduction ≥3.0 and a reduction between 2.0-2.9 were 0.41 (95% CI: 0.23-0.71) and 0.51 (95% CI: 0.34-0.76) (p for linear trend <0.001). LDL-C reduction yielded a decreased cerebrovascular event risk compared to no change, even with the smallest reduction (adjusted HR = 0.59, 95% CI: 0.36-0.98).
  
  
  CONCLUSIONS
  Decreasing LDL-C is associated with a reduced risk of cardiovascular and cerebrovascular events among T2DM patients without such pre-existing events. The magnitude of the protective effect on cerebrovascular events is less certain, and further studies are warranted.
authors: Boston Collaborative Drug Surveillance Program, Boston University, School of Public Health, USA.
authors: Lin
authors: L
authors: Li
authors: Global Health Outcomes, Merck & Co. Inc. Whitehouse Station, USA.
authors: Baishali M
authors: BM
authors: Ambegaonkar
authors: Royal United Hospital Bath NHS Trust, UK.
authors: John P D
authors: JP
authors: Reckless
authors: Boston Collaborative Drug Surveillance Program, Boston University, School of Public Health, USA sjick@bu.edu.
authors: Susan
authors: S
authors: Jick
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D006113:United Kingdom
chemical_list: D008078:Cholesterol, LDL
keywords: Low-density lipoprotein cholesterol; cardiovascular events; cerebrovascular events; type 2 diabetes mellitus