That is according to new research from the University of Central Florida. The authors pointed out that while some guidelines recommend statin use to achieve LDL-C goal under 70 mg/dL for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients at higher risk, others recommended against a target LDL-C level.
The authors of the new study published in the journal Drug Safety advised that achieving a target level that low usually requires the use of high-intensity statins, which have been associated with a higher risk of diabetes progression.
The study team sought to assess the association of strict (≤70 mg/dL) versus lenient (>70-100 mg/dL) LDL-C lowering on major adverse cardiovascular events (MACE), diabetes progression, diabetes microvascular complications, and total mortality in patients with diabetes.
The retrospective propensity score (PS)–matched study used a national cohort of predominantly male veterans diagnosed with diabetes without prior cardiovascular disease from fiscal years 2003 through 2015. All were initiated on a statin. The researchers focused on the difference between strict and lenient LDL-C lowering, taking into account 65 baseline characteristics, including comorbidities, risk scores, medication classes usage, vital signs, and laboratory data.
The key outcomes were defined as MACE, diabetes progression, microvascular diabetes complications, and total mortality.
Among the 80,110 eligible patients, the study team PS matched 21,294 pairs of statin initiators with strict or lenient LDL-C lowering. The veterans’ mean (SD) age was 64 (9.5) years, and the mean (SD) duration of follow-up was 6 (3) years.
The results indicated that MACE was similar in the PS-matched groups (6.1% in strict vs. 5.8% in lenient; odds ratio [OR]: 1.06; 95% CI, 0.98-1.15, P = .17). On the other hand, diabetes progression was higher among the strict versus lenient group (66.7% in strict vs. 64.1% in lenient; OR 1.12; 95% CI, 1.08-1.17, P <.001). No difference was determined in microvascular diabetes complications (22.3% in strict vs. 21.9% in lenient; OR 1.02; 95% CI, 0.98-1.07, P = .31), and no difference was found in total mortality (14.6% in strict vs. 15% in lenient; OR 0.97; 95% CI, 0.92-1.02, P = .20).
“Strict compared with lenient lowering of LDL-C with statins in men with diabetes without preexisting ASCVD did not decrease the risk of MACE but was associated with an increased diabetes progression,” the researchers concluded. “Clinicians should monitor their patients for diabetes progression upon escalating statins to achieve LDL-C levels ≤ 70 mg/dL.”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
