Efficacy of cholesterol-lowering therapy in 18 686 people with diabetes in 14 randomised trials of statins: a meta-analysis

Background: Although statin therapy reduces the risk of occlusive vascular events in people with diabetes mellitus, there is uncertainty about the effects on particular outcomes and whether such effects depend on the type of diabetes, lipid profile, or other factors. We undertook a prospective meta-analysis to help resolve these uncertainties. Methods: We analysed data from 18 686 individuals with diabetes (1466 with type 1 and 17 220 with type 2) in the context of a further 71 370 without diabetes in 14 randomised trials of statin therapy. Weighted estimates were obtained of effects on clinical outcomes per 1·0 mmol/L reduction in LDL cholesterol. Findings: During a mean follow-up of 4·3 years, there were 3247 major vascular events in people with diabetes. There was a 9% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol in participants with diabetes (rate ratio [RR] 0·91, 99% CI 0·82-1·01; p=0·02), which was similar to the 13% reduction in those without diabetes (0·87, 0·82-0·92; p