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Revista Portuguesa de Medicina Geral e Familiar
Print version ISSN 2182-5173
Abstract
LONGRAS, Carla; CAVADAS, Luís Filipe and CORDEIRO, Cátia. The impact of intensive LDL-c reduction on morbidity and mortality in patients with diabetes: an evidence-based review. Rev Port Med Geral Fam [online]. 2020, vol.36, n.1, pp.57-63. ISSN 2182-5173. https://doi.org/10.32385/rpmgf.v36i1.12574.
Objective: The aim of this review is to determine the impact of LDL-c reduction with statins on morbidity and mortality in patients with diabetes Methods: The search included studies, published between 1st January 2008 and 19th July 2018, in English, with the MeSH terms: Hydroxymethylglutaryl-CoA Reductase Inhibitors AND diabetes mellitus AND low-density lipoprotein AND morbidity; Hydroxymethylglutaryl-CoA Reductase Inhibitors AND diabetes mellitus AND low-density lipoprotein AND mortality. To assign the levels of evidence and recommendation forces, the American Academy of Family Physicians (AAFP) SORT scale was used. Results: A total of 174 articles were identified and three were selected: one meta-analysis and two clinical trials. The meta-analysis included 14 studies and demonstrated the benefit of statins in reducing the incidence of major vascular events in about 1/5 per mmol/L of LDL-c reduction. In the prospective clinical trial, the reduction of events was greater in the group with greater LDL-c reductions but there were no differences in all-cause mortality. In the retrospective clinical trial, there was a reduction of cardiovascular risk and all-cause mortality in the group assigned to statins compared to the control group. Conclusions: There were several limitations in the included studies, namely heterogeneous populations, short follow-up and methodological shortcomings. There seems to be a benefit in taking statins to lower LDL-c levels on the reduction of morbidity, cardiovascular events and all-cause mortality (strength of recommendation B). However, there is limited evidence about the recommended target LDL-c levels.
Keywords : Hydroxymethylglutaryl-CoA reductase inhibitors; Diabetes mellitus; Low-density lipoprotein; Morbidity; Mortality.
