Results from an Oxford University study, presented at the International Diabetes Federation congress in Cape Town, South Africa, show that patients not considered to be at high enough risk for statin therapy do benefit significantly from intensive lipid-lowering.

The AFORRD (Atorvastatin in Factorial with Omega-3 fatty acids Risk Reduction in Diabetes) study of 800 people with type 2 diabetes was designed to assess the degree to which a statin and/or omega-3 fatty acids affect the lipid profile and the estimated risk of cardiovascular disease.

The study found that, despite recruiting patients not considered to be at high enough risk to warrant statin therapy by their own doctors, 74% had a high estimated risk of cardiovascular disease, while 94% were at moderate-to-high risk.

Lipid-lowering with Pfizer’s Lipitor (atorvastatin) 20mg reduced harmful LDL-cholesterol in 91% of patients and significantly lowered the estimated 10-year CVD risk by 22%.

“The study shows that the majority of people with type 2 diabetes in primary care are at higher cardiovascular risk than previously thought,” commented Prof Andrew Neil, co-principal investigator of the study.

“The new guidelines from the Joint British Societies recommend statin treatment for the majority of people with type 2 diabetes, treating to a LDL-cholesterol target of 2mmol/l,” he said, but added that this advice was based on trials which recruited patients mainly in secondary care and who were at enhanced risk of CVD. “AFORRD shows that intensive lipid-lowering for most people with diabetes is the right approach for primary care too.”

Additional risk reduction

Prof Rury Holman, also co-principal investigator, added: “Although statin treatment is important, for many patients lipid lowering therapy alone may not reduce their CVD risk sufficiently, and additional risk reduction strategies still need to be considered.”

AFORRD also examined the effect of a pharmaceutical preparation of highly-purified fish oil - Solvay’s Omacor (omega-3 EE90) - and found that it reduced blood triglyceride levels by 5.6%, although there was no reduction in estimated CVD risk.

However, the Oxford University team points out that fish oils may reduce CVD risk in other ways, and further work is needed to find out more about their potential benefits. Full results of AFORRD will be published next year.