The benefits of statin therapy to lower cholesterol in patients with coronary heart disease are well established. Patients with type 2 diabetes have a high prevalence of coronary heart disease, and, while some consider type 2 diabetes a coronary risk factor, others consider it a disease equivalent. This raises the question ‘Should all diabetic patients receive statin therapy regardless of the presence of coronary heart disease?’ Review of the major secondary prevention lipid-lowering trials: the Scandinavian Simvastatin Survival study (4S study), the CARE trial, and the LIPID trial demonstrates that statin therapy is effective in reducing the incidence of major coronary events in diabetic patients. This supports the use of statin therapy in diabetic patients with known CHD, and the more recent HPS extends this recommendation to include patients with ‘low to normal’ cholesterols. The evidence for primary prevention in patients with diabetes has, until recently, been less clear, as the early primary prevention lipid-lowering studies had too few diabetic subjects to provide conclusive data. However, HPS and the recently published CARDS have shown that statin therapy results in a significant reduction in cardiovascular events, including coronary events, in patients with type 2 diabetes and no previous history of cardiovascular disease. Once again these benefits were seen in patients without ‘elevated’ cholesterol levels. On the basis of all of these studies it seems reasonable to treat all diabetic patients with statins regardless of previous cardiovascular disease or pre-treatment cholesterol levels.
