Lipid lowering in patients with diabetes mellitus: what coronary heart disease risk threshold should be used?

OBJECTIVE

To examine the impact for the UK population of providing statin treatment for diabetic patients for the primary prevention of coronary heart disease at a coronary event risk lower than currently recommended by the National Service Framework (NSF) for coronary heart disease.

DESIGN

Cross sectional survey.

SETTING

England 1998.

PARTICIPANTS

Nationally representative sample of 6879 subjects aged 35-74 years living in private households.

MAIN OUTCOME MEASURES

The proportion of the UK population recommended for statin treatment according to the NSF for coronary heart disease, and the proportion of the population with diabetes at a coronary disease event risk of > or = 15% over 10 years.

RESULTS

Of the 6879 subjects with total cholesterol measurements, 218 (3.2%) had diabetes mellitus. In this nationally representative sample, 6.3% of the subjects (95% confidence interval (CI), 5.7% to 6.9%) were candidates for statin treatment for the secondary prevention of coronary heart disease, including 0.7% (95% CI 0.5% to 0.9%) with diabetes. A further 2.4% (95% CI 2.0% to 2.8%), including 0.4% (0.2% to 0.6%) with diabetes, were identified as candidates for primary prevention of coronary heart disease according to the NSF for coronary heart disease. Lowering the primary prevention threshold for statin treatment to a coronary event risk of > or = 15% over 10 years in diabetic patients identified an additional 0.5% of the population.

CONCLUSIONS

Extending statin treatment to diabetic patients at a coronary heart disease risk of > or = 15% over 10 years would have a relatively small numerical impact in the UK population. Thus patients with diabetes mellitus should, as a minimum, be targeted for statin treatment at this level of risk.