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Gold, incentives and meh

Confusion over statins for diabetes

The Department of Health is refusing to issue new advice on prescribing statins to diabetes patients until an economic analysis is completed, plunging GPs into fresh confusion over statin prescribing.

Experts are united in calling for everyone with type 2 diabetes to be eligible for statins regardless of their cholesterol levels, after a major study found the drugs could substantially reduce their risk of heart attack or stroke.

The Collaborative Atorvastatin Diabetes study investigated the effects of a daily statin in 2,838 people with diabetes who had relatively low cholesterol but at least one additional risk factor.

Over the four years of the study, atorvastatin reduced the risk of a serious cardiovascular event by 37 per cent, with serious heart problems falling by 36 per cent and strokes by 48 per cent.

The department's current guidance says only that GPs should use their clinical judgment in deciding whether to prescribe statins to patients with diabetes below the 30 per cent CHD risk threshold.

But the new results suggest at least 500,000 diabetes patients in the UK with relatively low cholesterol levels should now start receiving a statin.

The study found there was 'no justification for having a cholesterol threshold for instigating statin treatment in type 2 diabetes patients'.

Placing so many patients on statins is likely to cost PCTs a small fortune, but GP diabetes experts insisted dramatic reductions in CVD would more than repay the expenditure.

Dr Eugene Hughes, Isle of Wight GP and member of Primary Care Diabetes Europe, said: 'We are clinicians not accountants and prevention is better than cure.

'If you don't put people on a statin then you are going to be managing their cardiovascular problems for years to come.'

Dr Peter Tasker, Kings Lynn GP and former head of Primary Care Diabetes UK, agreed diabetic patients 'ought to be on a statin'.

Current NICE guidance, which will not be revised until October 2005, restricts statins in patients with type 2 diabetes to those with LDL-cholesterol over 3mmol/litre.

The department will begin its economic analysis later in the summer.

By Cato Pedder

The Collaborative Atorvastatin Diabetes study (CARD)

•The CARD study looked at people with type 2 diabetes who had relatively low cholesterol levels and no history of CVD but at least one risk factor including high blood pressure or smoking

•Patients had to have an LDL-cholesterol of 4.14mmol/l or less with the average level at the start of the study of 3mmol/l

•During the study 83 patients on atorvastatin and 127 on placebo had a serious cardiovascular event

•Of the patients taking atorvastatin 61 died during the study, compared with 82 on placebo, a risk reduction of 27 per cent

•The study showed atorvastatin is safe and well-tolerated with no significant differences in treatment-related events in patients on the statin or placebo

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