Reduced Coronary Events in Simvastatin-Treated Patients With Coronary Heart Disease and Diabetes or Impaired Fasting Glucose Levels: Subgroup Analyses in the Scandinavian Simvastatin Survival Study
Abstract
BACKGROUND: Patients with diabetes mellitus (DM) have a marked increase in coronary heart disease (CHD) events relative to those without DM. In a previous report from the Scandinavian Simvastatin Survival Study using a clinical case definition of DM (n = 202), simvastatin-treated patients had significantly fewer CHD events compared with placebo-treated control subjects. OBJECTIVE: To examine the effect of simvastatin therapy on CHD in patients with DM and impaired fasting glucose levels. METHODS: Using the 1997 American Diabetes Association diagnostic criteria, we assessed the effect of simvastatin therapy post hoc for an average of 5.4 years in Scandinavian Simvastatin Survival Study patients with normal fasting glucose (n = 3237), impaired fasting glucose (n = 678), and DM (n = 483). RESULTS: Simvastatin-treated patients with DM had significantly reduced numbers of major coronary events (relative risk [RR] = 0.58; P = .001) and revascularizations (RR = 0.52; P = .005). Total (RR = 0.79; P = .34) and coronary (RR = 0.72; P = .26) mortality were also reduced in DM, but not significantly, due to small sample size. In impaired fasting glucose (IFG) subjects, simvastatin use significantly reduced the number of major coronary events (RR = 0.62; P = .003), revascularizations (RR = 0.57; P = .009), and total (RR = 0.57; P = .02) and coronary (RR = 0.45; P = .007) mortality. CONCLUSION: Our results extend previous findings in patients with DM to a larger cohort, confirming the benefit of cholesterol lowering with simvastatin treatment on CHD events. In addition, significant decreases in total mortality, major coronary events, and revascularizations were observed in simvastatin-treated patients with impaired fasting glucose levels. These results strongly support the concept that cholesterol lowering with simvastatin therapy improves the prognosis of patients with elevated fasting glucose levels (> or =6.0 mmol/L [> or =110 mg/ dL]) or DM and known CHD.
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For patients with established type 2 diabetes, clinical trials confirm that treating dyslipidemia and hypertension reduces cardiovascular risk.
“For patients with established type 2 diabetes mellitus, clinical trials confirm a reduction in cardiovascular risk from treatment of dyslipidemia 161-163,179 -181 and hypertension.91”
From Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement (2005) · cites this paper as [180]
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- Authors
- Haffner, S. M.
- Affiliations
- The University of Texas at San Antonio Health Science Center (US)
- Corresponding author
- Haffner, Steven M.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1999-12-13
- Volume
- 159
- Issue
- 22
- Pages
- 2661
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2171569022
- Cited by
- 441
- References
- 49
- Citations by year
- 2025: 1 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 7 · 2016: 4 · 2015: 9 · 2014: 11 · 2013: 8 · 2012: 15
- FWCI
- 30.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- simvastatin, coronary artery disease, diabetes mellitus, impaired fasting glucose, cholesterol lowering, major coronary events, revascularization, coronary heart disease mortality, all-cause mortality, Scandinavian Simvastatin Survival Study
- MeSH terms
- Anticholesteremic Agents, Blood Glucose, Coronary Disease, Diabetes Mellitus, Type 2, Double-Blind Method, Female, Humans, Cholesterol, LDL, Male, Middle Aged, Myocardial Revascularization, Prognosis, Scandinavian and Nordic Countries, Time Factors, Incidence, Survival Analysis, Glucose Intolerance, Simvastatin
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