Editor—Costa et al draw the principal conclusion that diabetic patients benefit more, in both primary and secondary prevention.1 But it is abundantly clear from their own analysis that the relative risk reduction was similar across all categories of patient
The numbers needed to treat remain as expected, reflecting, as they must, the absolute baseline risk and the 22% risk reduction across the board. Costa adds nothing new in recognising that, all other things being equal, diabetic patients have a higher absolute coronary risk. So what does this study add? There are no new important clinical implications, for primary prevention in patients with type 2 diabetes. It confirms that we should not change our guidelines.
Patients will benefit from lipid lowering in accordance with their absolute cardiovascular risk. We should continue to target treatment according to best available predictions of absolute cardiovascular risk. Progress will come from improving the targeting of those at greatest risk, the accuracy of risk prediction, and finding cheaper, safer, and more acceptable treatments.
Competing interests: None declared.
References
- 1.Costa J, Borges M, David C, Carneiro AV. Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: meta-analysis of randomised controlled trials. BMJ 2006;332: 1115-24. (13 May.) [DOI] [PMC free article] [PubMed] [Google Scholar]