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    Home > Active Ingredient News > Endocrine System > Which statin is best for reducing non-HDL-C and CVD risk in diabetic patients?

    Which statin is best for reducing non-HDL-C and CVD risk in diabetic patients?

    • Last Update: 2022-06-10
    • Source: Internet
    • Author: User
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    It is estimated that by 2025, type 2 diabetes will affect 380 million people worldwide, with a higher than normal risk of cardiovascular disease (CVD), and about 17.
    9 million people will die from CVD each year

    .

    Lowering blood low-density lipoprotein cholesterol (LDL-C) through lipid-lowering therapy, such as statins, is the cornerstone of primary and secondary prevention of CVD
    .

    Studies have confirmed that statins are the most effective drugs for reducing the risk of coronary heart disease in diabetic patients
    .

    The National Cholesterol Education Program recommends that LDL-C values ​​should be used to predict individual lipoprotein-related CVD risk
    .

     However, in patients receiving statins, non-high-density lipoprotein cholesterol (HDL-C) may be more closely associated with CVD because non-HDL-C contains all the bad types of cholesterol, such as LDL, lipoproteins, Density lipoprotein and very low density lipoprotein residues, etc.
    , but LDL-C does not, so it may be better than LDL-C to assess CVD risk and treatment effect

    .

    In April 2021, the UK National Institute for Health and Care Excellence (NICE) updated its adult diabetes guidelines, suggesting that non-HDL-C should replace LDL-C as the primary target of lipid-lowering therapy to reduce CVD risk
    .

    In addition, non-HDL-C calculations are simple and clinicians can calculate by subtracting HDL-C from total cholesterol levels
    .

     A recent network meta-analysis, published in BMJ, compared the efficacy of different types and doses of statins for reducing non-HDL-C levels to prevent CVD risk in people with diabetes
    .

    Methods We included randomised controlled trials comparing different types and doses of statins, including placebo, in adults with type 1 or type 2 diabetes in the Medline, Cochrane Central Register of Controlled Trials and Embase databases
    .

    The primary endpoint was change in non-HDL-C levels, calculated from measurements of total cholesterol and HDL-C
    .

    Secondary end points were changes in LDL-C and total cholesterol levels, major cardiovascular events (non-fatal stroke, non-fatal myocardial infarction, and CVD death), and discontinuation due to adverse events
    .

     A Bayesian random-effects network meta-analysis was used to evaluate different doses of statins (low, moderate, or high: according to the guideline, statins were divided into three dose strengths by percentage of LDL-C reduction: 20%-30% reduction in Low dose; 31%-39% reduction is intermediate dose; ≥40% reduction is high dose) to reduce the therapeutic effect of non-HDL-C
    .

    Subgroup analyses compared those at higher risk for major cardiovascular events with those at low/intermediate risk
    .

    Findings Of 42 randomized controlled trials involving 20,193 people with diabetes, 11,698 were included in the meta-analysis
    .

    Compared with placebo, high (-2.
    31mmol/L, 95%CI: -3.
    39 to -1.
    21) and moderate (-2.
    27mmol/L, -3.
    00 to -1.
    49) doses of rosuvastatin and high doses of Vastatin (-2.
    26mmol/L, -2.
    99 to -1.
    51) and high-dose atorvastatin (-2.
    20mmol/L, -2.
    69 to -1.
    70) had the greatest reductions in non-HDL-C levels

    .

     Atorvastatin and simvastatin at any dose, as well as low-dose pravastatin, were effective in reducing non-HDL-C levels
    .

     Among the 4670 patients at high risk of major cardiovascular events, high-dose atorvastatin reduced non-HDL-C levels most significantly (-1.
    98mmol/L, -4.
    16 to 0.
    26)

    .

    High-dose simvastatin (-1.
    93mmol/L, -2.
    63 to -1.
    21) and rosuvastatin (-1.
    76mmol/L, -2.
    37 to -1.
    15) were the most effective options for lowering LDL-C

    .

    Compared with placebo, moderate-dose atorvastatin significantly reduced the incidence of non-fatal myocardial infarction (relative risk = 0.
    57, 95% CI: 0.
    43 to 0.
    76, n = 4 studies)

    .

    No significant differences were found in drug discontinuation, non-fatal stroke, and CVD death
    .

    Conclusions This network meta-analysis showed that moderate and high doses of rosuvastatin and high doses of simvastatin and atorvastatin were most effective in reducing non-HDL-C levels in diabetic patients, reducing non-HDL-C levels within 12 weeks.
    The concentration decreased by 2.
    20-2.
    31mmol/L

    .

     In patients at high risk for major cardiovascular events (secondary prevention), high-dose atorvastatin minimizes non-HDL-C (approximately 2.
    0 mmol/L)

    .

     The accuracy of predicting CVD may be improved when the primary goal is to reduce non-HDL-C levels
    .

    These findings are useful to assist clinicians in decision-making and support guidelines for lipid management in diabetic patients with non-HDL-C as the primary goal
    .

    Source: [1]Fran Lowry.
    The Best Statins to Lower Non-HDL Cholesterol in Diabetes?.
    Medscape.
    April 13, 2022.
    [2]HODKINSON A, TSIMPIDA D, KONTOPANTELIS E, et al.
    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 [J].
    BMJ, 2022, 376: e067731.

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