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Lipid intervention trials in diabetes.

G Steiner1

  • 1Department of Medicine, Toronto Hospital (General Division), Ontario, Canada.

Diabetes Care
|June 22, 2000
PubMed
Summary

Lipid intervention trials often exclude diabetic patients. While some subgroup analyses show benefits in diabetes, new primary prevention studies are underway to confirm lipid reduction

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Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Most lipid intervention trials for coronary artery disease prevention exclude individuals with diabetes.
  • Existing evidence for lipid reduction benefits in diabetes comes from post hoc analyses of trials like the Scandinavian Simvastatin Survival Study (4S) and the Cholesterol and Recurrent Events Trial (CARE).

Purpose of the Study:

  • To review the current evidence for lipid intervention in diabetic populations.
  • To highlight ongoing and upcoming clinical trials specifically designed to test the "lipid hypothesis" in diabetes.

Main Methods:

  • Review of existing clinical trial data, focusing on subgroup analyses in diabetic patients.
  • Description of ongoing and planned primary and secondary intervention trials in diabetes.

Main Results:

  • Post hoc analyses of gemfibrozil (Helsinki Heart Study) showed a trend towards reduced coronary events in diabetics, but lacked statistical significance.
  • Secondary intervention trials (4S, CARE) using statins demonstrated significant reductions in coronary events in diabetic subgroups, though these were hypercholesterolemic populations.

Conclusions:

  • Existing evidence for lipid reduction in diabetes is limited and requires cautious interpretation due to post hoc nature and population characteristics.
  • Several large-scale primary prevention trials (FIELD, CARDS, LDS) and an angiographic study (DAIS) are ongoing to provide definitive evidence on lipid management in diabetes.

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