Efficacy of standard and intensive statin treatment for the secondary prevention of cardiovascular and cerebrovascular events in diabetes patients: a meta-analysis.
OBJECTIVE
To estimate the efficacy of standard and intensive statin treatment in the secondary prevention of major cardiovascular and cerebrovascular events in diabetes patients.


METHODS
A systematic search was conducted in Medline over the years 1990 to September 2013. Randomized, double-blind, clinical trials comparing a standard-dose statin with placebo or a standard-dose statin with an intensive-dose statin for the secondary prevention of cardiovascular and cerebrovascular events in diabetes patients were selected. Trial and patient characteristics were extracted independently by two researchers. The combined effect on the composite primary endpoint was measured with a fixed-effect model. Potential publication bias was examined with a funnel plot.


RESULTS
Five trials were included in the analysis comparing standard-dose statins with placebo with a total of 4 351 participants. Four trials were included for comparing standard-dose with intensive-dose statins, including 4 805 participants. Compared with placebo, standard-dose statin treatment resulted in a significant relative risk (RR) reduction of 15% in the occurrence of any major cardiovascular or cerebrovascular event (RR 0.85, 95% CI 0.79-0.91). Compared with standard-dose statin treatment, intensive-dose statin treatment resulted in an additional 9% relative risk reduction (RR 0.91, 95% CI 0.84-0.98).


CONCLUSIONS
Treatment with standard-dose statins to prevent cardiovascular or cerebrovascular events in diabetes patients with manifest cardiovascular disease results in an estimated 15% relative risk reduction and intensive-dose statin treatment adds 9%. If proven cost-effective, more intensive statin treatment should be recommended for diabetes patients at high cardiovascular risk.
University Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.
Folgerdiena M
FM
de Vries
University Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.
Johan
J
Kolthof
University Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.
Maarten J
MJ
Postma
Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Petra
P
Denig
University Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.
Eelko
E
Hak
D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D048909:Diabetes Complications / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D055502:Secondary Prevention; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors