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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.


    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.


     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?.
    April 13, 2022.
    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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