CARDIOVASCULAR MEDICINE

Lipid lowering in patients with diabetes mellitus: what coronary heart disease risk threshold should be used?

K Rowland Yeo, W W Yeo

Clinical Pharmacology and Therapeutics, Division of Clinical Sciences, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK

Correspondence to:
Correspondence to:
Dr K Rowland Yeo, Clinical Pharmacology and Therapeutics, Floor L, Royal Hallamshire Hospital, Sheffield S10 2JF, UK;
k.r.yeo{at}sheffield.ac.uk

Objective: To examine the impact for the UK population of providing statin treatment for diabetic patients for the primary prevention of coronary heart disease at a coronary event risk lower than currently recommended by the National Service Framework (NSF) for coronary heart disease.

Design: Cross sectional survey.

Setting: England 1998.

Participants: Nationally representative sample of 6879 subjects aged 35–74 years living in private households.

Main outcome measures: The proportion of the UK population recommended for statin treatment according to the NSF for coronary heart disease, and the proportion of the population with diabetes at a coronary disease event risk of 15% over 10 years.

Results: Of the 6879 subjects with total cholesterol measurements, 218 (3.2%) had diabetes mellitus. In this nationally representative sample, 6.3% of the subjects (95% confidence interval (CI), 5.7% to 6.9%) were candidates for statin treatment for the secondary prevention of coronary heart disease, including 0.7% (95% CI 0.5% to 0.9%) with diabetes. A further 2.4% (95% CI 2.0% to 2.8%), including 0.4% (0.2% to 0.6%) with diabetes, were identified as candidates for primary prevention of coronary heart disease according to the NSF for coronary heart disease. Lowering the primary prevention threshold for statin treatment to a coronary event risk of 15% over 10 years in diabetic patients identified an additional 0.5% of the population.

Conclusions: Extending statin treatment to diabetic patients at a coronary heart disease risk of 15% over 10 years would have a relatively small numerical impact in the UK population. Thus patients with diabetes mellitus should, as a minimum, be targeted for statin treatment at this level of risk.

Keywords: diabetes; coronary heart disease; risk estimate; statins

Abbreviations: AFCAPS/TexCAPS, Airforce/Texas coronary atherosclerosis prevention study; NSF, National Service Framework; WOSCOP, west of Scotland coronary prevention study

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