In the setting of acute coronary syndrome (ACS), the risks of death and ischemic complications are high in diabetic patients, and given that dyslipidemia is a major contributing factor to poor outcomes it is of interest to observe the effects of lipid-lowering therapy in these patients.

In previously published data from the PROVE IT-TIMI 22 trial which looked at the effects of intensive versus standard statin therapy on ischemic complications in patients with ACS, the importance of looking at achieved LDL cholesterol (LDL-C) as well as high-sensitivity C-reactive protein (hsCRP) levels was seen, in terms of improved stratification of risk for recurrent myocardial infarction or death (1).

In the present analysis, the subset of diabetic patients in the PROVE IT-TIMI 22 trial was studied to see the effects of intensive versus standard statin therapy on clinical outcomes, as well as LDL-C and hsCRP levels. The diabetic patients were found to have a similar relative reduction in clinical outcomes with intensive statin therapy to those without diabetes, however the diabetic patients were less able to achieve the dual LDL-C and hsCRP goal, and the ones not achieving the dual goal had a high event rate. This points to the need for additional therapies in addition to intensive statin therapy to achieve the goals of therapy and reduce events in diabetic patients with ACS.

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1. Paul M Ridker, M.D., Christopher P. Cannon, M.D., David Morrow, M.D., Nader Rifai, Ph.D., Lynda M. Rose, M.S., Carolyn H. McCabe, B.S., Marc A. Pfeffer, M.D., Ph.D., Eugene Braunwald, M.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 (PROVE IT–TIMI 22) InvestigatorsC-Reactive Protein Levels and Outcomes after Statin Therapy N Engl J Med. 2005 Jan 6;352(1):20-8.