Abstract 14311: HMG CoA Reductase Inhibitor Therapy Does Not Alter the Relationship Between High Density Lipoprotein Cholesterol and Cardiovascular Risk in the Diabetic Population: A Meta-Analysis
Background: Despite the use of HMG-CoA reductase inhibitors (statins) to reach stringent low-density lipoprotein cholesterol (LDL-C) goals, diabetics remain at disproportionate residual risk for cardiovascular disease (CVD). High-density lipoprotein cholesterol (HDL-C), an inverse correlate of CVD risk, is at low levels in typical diabetic dyslipidemia. The extent to which the association between HDL-C level and CVD risk is affected by statin therapy in diabetics, however, is unknown. We sought to determine whether statin therapy modifies the HDL-C/CVD risk relationship in diabetic patients.
Methods: Randomized controlled trials (RCTs) of statin therapy reporting lipid profiles and CVD event rates in diabetics were identified via MEDLINE. Weighted Poisson meta-regressions delineated the relationship of HDL-C to the risk of myocardial infarction (MI).
Results: Data were analyzed from 6 statin-related RCTs including 14,531 diabetics (61,404 person years of follow-up). The significant inverse association between HDL-C and MI remained after adjusting for LDL-C, age, smoking, and hypertension (p<0.001 for statin and control arms, FIGURE). Importantly, the regression line slope was similar in these two groups (p=0.142), suggesting statins did not alter the inverse association between HDL-C and MI. In this population, the incidence of MI was lower by 24.5 and 24.8 MIs/1000 person years in statin and control arms, respectively, at an HDL-C level of 45 compared to that at 35 mg/dL. This is a substantially stronger relationship than we reported in previous studies including non-diabetics (7.6 and 7.8/1000 person year reduction in MI rate for these respective groups). In comparison, statin therapy reduced MI rate by approximately 6/1000 person years irrespective of HDL-C.
Conclusion: Statin therapy does not alter the robust inverse association between HDL-C and MI risk in diabetics. Low HDL-C is likely an important component of residual CVD risk in this population.
- © 2011 by American Heart Association, Inc.