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The waiting game

GPs urged to use statins in every patient with diabetes

By Emma Wilkinson

Every diabetic patient ­ including those with normal cholesterol levels ­ should be treated with a statin, according to a key Government adviser.

The call came from GP academic Professor Mike Pringle, who has been handed the task by ministers of ensuring the diabetes national service frame- work gets put into practice.

He was speaking after latest results from an international trial of 9,000 patients with established coronary heart disease found statins offer a 'substantially greater' absolute risk reduction in diabetic patients.

Only 23 patients with diabetes had to be treated to prevent a death or heart attack compared with 39 patients with normal fasting glucose, show results from the long-term intervention with pravastatin in ischaemic disease (LIPID) trial.

Statin treatment reduced the risk of a cardiovascular event by 21 per cent and of a stroke by 39 per cent in patients with diabetes.

All patients in the study had total cholesterol between 4 and 7mmol/l. They were randomised to either 40mg of pravastatin daily for six years or placebo, according to a report in Diabetes Care.

Professor Pringle, professor of general practice at the University of Nottingham and co-chair of the diabetes framework delivery strategy group, said: 'There is a strong consensus that people with diabetes should be treated energetically with statins.'

Even diabetic patients with 'normal' cholesterol levels should be on statins, he stressed.

Dr John Pittard, a GP in Staines, Middlesex, and a member of the group that wrote the CHD national service framework, said GPs' approach to statin use in diabetics was developing 'in a piecemeal way' and many GPs still had lists of 'statin neglected' diabetic patients.

But he said the new GMS contract offered 'no big incentive' for GPs to prescribe statins for diabetic patients without CHD.

The diabetes framework and guidance from the National Institute for Clinical Excellence both recommend statin use in diabetics with high cholesterol but give no advice on patients with normal lipid levels.

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