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Statins and alirocumab ‘may significantly reduce heart disease risk in diabetic patients’

Using a combination of statins and alirocumab to treat patients with diabetes and a history of acute coronary syndrome (ACS) may significantly reduce their risk of further cardiac events, according to the analysis of a recent clinical trial. 

People with a history of ACS, which includes heart attack or unstable angina, are at greater risk of experiencing a further cardiac event in the future than those with no cardiac history. However, the risk of cardiovascular events is even higher among patients with diabetes as excess glucose in the blood can damage blood vessels, disrupting the flow of blood to the heart and brain, which increases heart attack and stroke risk. 

Results of the trial, first published in March 2018, examined the extent of “absolute risk reduction” (ARR) in patients with a history of ACS who had either diabetes, prediabetes, or normal glucose levels. Entitled Alirocumab and Cardiovascular Outcomes in Patients with Acute Coronary Syndrome and Diabetes - Prespecified Analyses of Odyssey Outcomes, the study was presented at the 78th Scientific Sessions of the American Diabetes Association (ADA). 

It suggested patients with diabetes and a history of cardiac events who are prescribed statins and the monoclonal human antibody alirocumab could reduce their risk of future episodes by more than double that of people taking the same medication who have normal blood glucose or prediabetes. 

“One reason for the success of the medication combination in this group is that their absolute risk was so high; the other groups that took the alirocumab also derived benefit, but the benefit was slightly less because their risk was lower,” explained Kausik Ray, MD, professor of public health, department of public health and primary care at the School of Public Health of Imperial College in London.

Patients involved in the trial were injected with alirocumab once every fortnight and were also prescribed the maximum-tolerated statin medication. The researchers found this combination of medication may almost double the ARR (2.3 percent) in patients who had diabetes and a history of ACS, significantly reducing the risk of major adverse cardiac events, such as stroke, hospitalization for angina, nonfatal myocardial infarction, and coronary heart disease death.

“These results suggest intensive cholesterol-lowering using the combination of statins and alirocumab offers us a means to significantly reduce heart disease risk in this patient population,” Ray asserted.

Diabetes is one of the most common conditions in the United States, affecting nearly one in ten people, according to the latest National Diabetes Statistics Report from the Centers for Disease Control and Prevention. Type 2 diabetes is the most common form of the condition, accounting for approximately nine out of ten cases. 

Statins, such as Lipitor (atorvastatin) or Crestor (rosuvastatin), are commonly prescribed to diabetes patients to help control risk factors such as high cholesterol and high blood pressure, which can increase the risk of heart disease. In 2017, the ADA recommended that all patients with diabetes take statins to control these risk factors, but it also placed “substantial emphasis” on the importance of lifestyle changes in managing the condition, for example, improving diet and getting more exercise.