Association Between Use of Lipid-Lowering Therapy and Cardiovascular Diseases and Death in Individuals With Type 1 Diabetes

Abstract

OBJECTIVE To evaluate the effect of lipid-lowering therapy (LLT) in primary prevention on cardiovascular disease (CVD) and death in type 1 diabetes.

RESEARCH DESIGN AND METHODS We used the Swedish National Diabetes Register to perform a propensity score–based study. Propensity scores for treatment with LLT were calculated from 32 baseline clinical and socioeconomic variables. The propensity score was used to estimate the effect of LLT in the overall cohort (by stratification).

We estimated risk of acute myocardial infarction, stroke, coronary heart disease, and cardiovascular and all-cause mortality in individuals with and without LLT using Cox regression. A total of 24,230 individuals included in 2006–2008 with type 1 diabetes without a history of CVD were followed until 31 December 2012; 18,843 were untreated and 5,387 treated with LLT (97% statins). The mean follow-up was 6.0 years.

RESULTS The propensity score allowed balancing of all 32 covariates, with no differences between treated and untreated after accounting for propensity score.

Hazard ratios (HRs) for treated versus untreated were as follows:

cardiovascular death 0.60 (95% CI 0.50–0.72),

all-cause death 0.56 (0.48–0.64),

fatal/nonfatal stroke 0.56 (0.46–0.70),

fatal/nonfatal acute myocardial infarction 0.78 (0.66–0.92),

fatal/nonfatal coronary heart disease 0.85 (0.74–0.97),

and fatal/nonfatal CVD 0.77 (0.69–0.87).

CONCLUSIONS This observational study shows that LLT is associated with 22–44% reduction in the risk of CVD and cardiovascular death among individuals with type 1 diabetes without history of CVD and underlines the importance of primary prevention with LLT to reduce cardiovascular risk in type 1 diabetes.

 

Kommentar
Detta är den största observationella studie som är publicerad fram till nu. Den visar en uttalat positiv effekt av lipidsänkande behandling vid primär prevention av typ 1 diabetes patioenter. Patienterna hade en medelålder av 39,4 år. Att behandla ger substantiellt minskad morbiditet och mortalitet.

Aktuella riktlinjer för T1DM rekommenderar utskrivning av statiner till patienter 40 år eller äldre. Aktuell studie har inte speciellt analyserat statineffekt på individer under 40 år, också pga relatuivt få hårda endpoints i gruppen under 40 år.  

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