patients with and without type 2 diabetes. Each trial had a follow up period of at least three years. Ten of the trials used a statin and two trials used gemfibrozil.

For both primary and secondary prevention the risk reduction for major coronary events was 21% in diabetic patients and 23% in non-diabetic patients. However, the absolute risk reduction was three times higher for secondary prevention, reflecting the higher baseline risk of patients in secondary prevention trials, the authors said.

When the data was adjusted for the patient's baseline risk level, compared with non-diabetic patients, diabetic patients were shown to benefit more from lipid lowering therapy for secondary prevention of coronary artery disease death (benefit per 1,000 patients, 16 and 53, respectively).

Although the benefits of statins for secondary prevention of coronary artery disease have been well documented, they are not being optimally used in patients at higher risk - the ones most likely to benefit, the authors commented.

Evidence from trials has shown that lipid lowering therapy would benefit diabetic patients with a cholesterol level over 3.4 mmol/l. The evidence strongly supports using a statin as first line lipid-lowering therapy. However, if a patient had a high triglyceride level or a combination of very high cholesterol and triglyceride levels, a fibrate may be more appropriate.

Reference: Adopted from Medicine Today, July 2006