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Submitted on September 19, 2005
Accepted on November 8, 2005
Department of Medicine, College of Physicians and Surgeons of Columbia University
* To whom correspondence should be addressed. E-mail: hng1{at}columbia.edu.
Context: The Adult Treatment Panel III recommends HMG-CoA reductase inhibitors, or statins, as first line lipid-altering therapy for all adult patients with diabetes mellitus. This is based on the well-characterized efficacy and safety profiles of this class of agents, as well as several clinical trials demonstrating that statin treatment reduces the risk of cardiovascular events.
Evidence Acquisition: This review provides an overview of the effectiveness and mechanisms of action of statins in patients with diabetes mellitus using small efficacy trials and large clinical outcomes trials, as well as studies of the effects of statins on apolipoprotein B (apoB) metabolism.
Evidence Synthesis: The major findings presented are a review of mechanistic studies of selected subjects with diabetes mellitus and dylipidemia, and a compilation of results from large-scale clinical trials of patients with diabetes.
Conclusions: Statins are highly efficacious as low-density lipoprotein (LDL) cholesterol-lowering agents, and have more modest effects on very-low-density lipoprotein (VLDL) triglyceride, and high-density lipoprotein (HDL) cholesterol levels. The effects of statins on plasma lipids and lipoproteins result from their ability to both increase the efficiency with which VLDL and LDL are cleared from the circulation, and reduce the production of apoB-containing lipoproteins by the liver. Further investigations are needed to clarify the mechanisms whereby statins reduce apoB secretion from the liver.
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