Moderate-intensity statin therapy seems ineffective in primary cardiovascular prevention in patients with type 2 diabetes complicated by nephropathy. A multicenter prospective 8 years follow up study

Ferdinando Carlo Sasso, Nadia Lascar, Antonella Ascione, Ornella Carbonara, Luca De Nicola, Roberto Minutolo, Teresa Salvatore, Maria Rosaria Rizzo, Plinio Cirillo, Giuseppe Paolisso, Raffaele Marfella, NID-2 study group, Ferdinando Carlo Sasso, Nadia Lascar, Antonella Ascione, Ornella Carbonara, Luca De Nicola, Roberto Minutolo, Teresa Salvatore, Maria Rosaria Rizzo, Plinio Cirillo, Giuseppe Paolisso, Raffaele Marfella, NID-2 study group

Abstract

Background: Although numerous studies and metanalysis have shown the beneficial effect of statin therapy in CVD secondary prevention, there is still controversy such the use of statins for primary CVD prevention in patients with DM. The purpose of this study was to evaluate the occurrence of total major adverse cardio-vascular events (MACE) in a cohort of patients with type 2 diabetes complicated by nephropathy treated with statins, in order to verify real life effect of statin on CVD primary prevention.

Methods: We conducted an observational prospective multicenter study on 564 patients with type 2 diabetic nephropathy free of cardiovascular disease attending 21 national outpatient diabetes clinics and followed them up for 8 years. 169 of them were treated with statins (group A) while 395 were not on statins (group B).

Results: Notably, none of the patients was treated with a high-intensity statin therapy according to last ADA position statement. Total MACE occurred in 32 patients from group A and in 68 patients from group B. Fatal MACE occurred in 13 patients from group A and in 30 from group B; nonfatal MACE occurred in 19 patients from group A and in 38 patients from group B. The analysis of the Kaplan-Meier survival curves showed a not statistically significant difference in the incidence of total (p 0.758), fatal (p 0.474) and nonfatal (p 0.812) MACE between the two groups. HbA1c only showed a significant difference in the incidence of MACE between the two groups (HR 1.201, CI 1.041-1.387, p 0.012).

Conclusions: These findings suggest that, in a real clinical setting, moderate-intensity statin treatment is ineffective in cardiovascular primary prevention for patients with diabetic nephropathy. Trial registration ClinicalTrials.gov Identifier NCT00535925. Date of registration: September 24, 2007, retrospectively registered.

Keywords: CVD; Diabetes; Nephropathy; Primary prevention; Statin.

Figures

Fig. 1
Fig. 1
Kaplan–Meier estimates of total major adverse CV events in statin-treated group (green line) and non-statin-treated group (blue line), during the average follow-up of 8 years
Fig. 2
Fig. 2
Rate of patients of both groups at target for major CV risk factors at ending of follow-up (8 years)

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