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Secondary Prevention of Cardiovascular Events With Long-Term Pravastatin in Patients With Diabetes or Impaired Fasting Glucose
Open accessAbstract
OBJECTIVE—Diabetes, a major health problem worldwide, increases the risk of cardiovascular disease and its associated mortality. Evidence of the overall benefits of lipid modification in this area is needed. RESEARCH DESIGN AND METHODS—The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial showed that cholesterol-lowering treatment with pravastatin reduced mortality and coronary heart disease (CHD) events in 9,014 patients aged 31–75 years with CHD and total cholesterol 4.0–7.0 mmol/l. We measured the effects of pravastatin therapy, 40 mg/day over 6.0 years, on the risk of CHD death or nonfatal myocardial infarction and other cardiovascular outcomes in 1,077 LIPID patients with diabetes and 940 patients with impaired fasting glucose (IFG). RESULTS—In patients allocated to placebo, the risk of a major CHD event was 61% higher in patients with diabetes and 23% higher in the IFG group than in patients with normal fasting glucose, and the risk of any cardiovascular event was 37% higher in the diabetic group and 19% higher in the IFG group. Pravastatin therapy reduced the risk of a major CHD event overall from 15.9 to 12.3% (relative risk reduction [RRR] 24%, P < 0.001) and from 23.4 to 19.6% in the diabetic group (19%, P = 0.11); in the diabetic group, the reduction was not significantly different from the reductions in the other groups. Pravastatin reduced the risk of any cardiovascular event from 52.7 to 45.2% (21%, P < 0.008) in patients with diabetes and from 45.7 to 37.1% (26%, P = 0.003) in the IFG group. Pravastatin reduced the risk of stroke from 9.9 to 6.3% in the diabetic group (RRR 39%, CI 7–61%, P = 0.02) and from 5.4 to 3.4% in the IFG group (RRR 42%, CI −9 to 69%, P = 0.09). Pravastatin did not reduce the incidence of diabetes. Over 6 years, pravastatin therapy prevented one major CHD event (CHD death or nonfatal myocardial infarction) in 23 patients with IFG and 18 patients with diabetes. A meta-analysis of other major trials confirmed the high absolute risks of diabetes and IFG and the absolute benefits of statin therapy in these patients. CONCLUSIONS—Cholesterol-lowering treatment with pravastatin therapy prevents cardiovascular events, including stroke, in patients with diabetes or IFG and established CHD.
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“Statins remain the first-line therapy for patients with hypertriglyceridemia, having demonstrated consistent reductions in ASCVD events across a wide range of populations, including those with elevated triglycerides.”
From Targeting Triglycerides in Cardiovascular Disease Prevention: Evidence, Mechanisms, and Emerging Therapies (2026) · cites this paper as [83]
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“Subgroup data from the LIPID trial further showed significant benefit in patients with diabetes and mixed dyslipidemia, many of whom had elevated TG levels [83].”
From Targeting Triglycerides in Cardiovascular Disease Prevention: Evidence, Mechanisms, and Emerging Therapies (2026) · cites this paper as [83]
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Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials
Sattar, N., Preiss, D., Murray, H. M., Welsh, P., Buckley, B. M., de Craen, A. J., Seshasai, S. R. K., McMurray, J. J., Freeman, D. J., Jukema, J. W., et al. (2010) · The Lancet · doi:10.1016/s0140-6736(09)61965-6 · Cited by 2,436
Creager, M. A., Lüscher, T. F., of, P. W. T. A., Cosentino, F., & Beckman, J. A. (2003) · Circulation · doi:10.1161/01.cir.0000091257.27563.32 · Cited by 1,675
Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I
Paneni, F., Beckman, J. A., Creager, M. A., & Cosentino, F. (2013) · European Heart Journal · doi:10.1093/eurheartj/eht149 · Cited by 1,455
Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update
Mosca, L. J., Banka, C. L., Benjamin, E. J., Berra, K. A., Bushnell, C., Dolor, R. J., Ganiats, T. G., Gomes, A. S., Gornik, H. L., Gracia, C., et al. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.02.020 · Cited by 753
Metadata
- Authors
- Keech, A., Colquhoun, D., Best, J., Kirby, A., Simes, R. J., Hunt, D., Hague, W., Beller, E., Arulchelvam, M., Baker, J., Tonkin, A., & for the LIPID Study Group
- Affiliations
- The University of Sydney (AU)
- Wesley Hospital (AU)
- St Vincent's Hospital Melbourne (AU)
- The Royal Melbourne Hospital (AU)
- National Heart Foundation of Australia (AU)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2003-10-01
- Volume
- 26
- Issue
- 10
- Pages
- 2713-2721
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2086139919
- Cited by
- 313
- References
- 36
- Citations by year
- 2026: 4 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 5 · 2020: 3 · 2019: 11 · 2018: 7 · 2017: 6 · 2016: 11 · 2015: 13 · 2014: 14 · 2013: 21 · 2012: 14
- FWCI
- 26.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Griffith Research Online (submittedVersion)
- Funders
- Bristol-Myers Squibb
- National Heart Foundation of Australia
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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
- pravastatin, secondary prevention, cardiovascular events, diabetes mellitus, impaired fasting glucose, coronary artery disease, myocardial infarction, stroke, LIPID trial, cholesterol-lowering therapy, statins, cardiovascular risk reduction, hypercholesterolemia, diabetes incidence, nonfatal myocardial infarction, cardiovascular hospitalization
- MeSH terms
- Adult, Aged, Angina, Unstable, Anticholesteremic Agents, Blood Glucose, Cardiovascular Diseases, Coronary Artery Disease, Diabetes Mellitus, Type 2, Fasting, Female, Follow-Up Studies, Humans, Hyperlipidemias, Male, Middle Aged, Myocardial Infarction, Risk Factors, Treatment Outcome, Pravastatin, Glucose Intolerance, Stroke, Coronary Restenosis
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