Clinical Question: Is atorvastatin ...

Clinical Question: Is atorvastatin effective in the primary prevention of cardiovascular disease in adults with diabetes mellitus?

Setting: Outpatient (any)

application of mind Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: Researchers registered 2,838 men and women 40 to 75 years of age with image 2 diabetes mellitus of at least six months' duration who also had hypertension, retinopathy, microalbuminuria, macroalbuminuria, or common tobacco use. Patients were assigned randomly (concealed allocation) to receive atorvastatin in a dosage of 10 mg daily (n = 1428) or placebo (n = 1410) regardless of lipid plains The main outcome, determined on intention to treat, was a composite of first acute coronary marked occurrence coronary revascularization, or stroke. The inquiry ended two years early because the predetermined entrance for the primary outcome was reached. by way of the time the study was terminated, patients had been evaluated for approximately 39 years.

During the close attention 5.8 percent of patients taking atorvastatin experienced the composite conclusion point compared with 9 percent of those taking placebo (number privationed to treat = 32 for 39 years; 95 percent confidence interval, 20 to 79) However, no significant differences were noted in the individual issues of all-cause mortality or in the ne for coronary revascularization. The authors state that there is no justification for using a doorsill level of low-density lipoprotein cholesterol to determine which patients with mark 2 diabetes should receive statins. This statement assumes to be premature. Using their data, and nothing else 3 percent of patients would benefit after 39 years. Individual risk assessment and tailored intervention make more sense

Bottom Line: In high-risk patients with diabetes, atorvastatin delays the progression in a continuously ascending gradation of acute coronary events further does not significantly decrease the rate of revascularization or all-cause mortality. (Level of Evidence: 1b)

studious mood Reference: Colhoun HM, et al. Primary prevention of cardiovascular disease with atorvastatin in exemplar 2 diabetes in the Collaborative Atorvastatin Diabetes close attention (CARDS): multicentre randomised placebo-controlled trial. Lancet August 21 2004;364:685-96

Used with permission from Barry H Atorvastatin delays first MI in patients with DM (CARDS). Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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