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From Reuters Health Information

Statins Linked to Accelerated Coronary Calcification in Diabetics

By Frederik Joelving

NEW YORK (Reuters Health) Aug 29 – Type 2 diabetics with frequent statin use had greater progression of coronary artery calcification (CAC) than people who reported less frequent use, in a new study of U.S. veterans.

The results are in keeping with earlier trials showing statins do not halt CAC progression in largely nondiabetic populations. Although the new study was observational, the researchers attribute the vascular changes to the drugs.

“Our study shows for the first time that statins actually appear to promote calcification in patients with longstanding type 2 diabetes, despite optimal lipid levels and regardless of prior heart and vascular disease,” Dr. Aramesh Saremi of the Phoenix VA Health Care System told Reuters Health by email.

“This is a critical first step in clarifying the impact of statins on future cardiovascular events in the setting of extensive vascular calcification in this population of type 2 diabetes patients with longstanding disease, and in refining our understanding of statin effects on vascular health,” she added.

Dr. Saremi and colleagues, whose findings were published online August 8 in Diabetes Care, analyzed data from the Veterans Affairs Diabetes Trial on 197 type 2 diabetics with extensive atherosclerosis at baseline. Statin use was reported at 14 to 28 study visits, three months apart.

Patients who reported statin use at more than half of the visits (82%) had more cardiovascular disease at baseline – but they had lower total and low-density lipoprotein (LDL) cholesterol levels at the end of the study compared to less frequent users.

Based on computed tomography scans done on average 4.6 years apart, however, the frequent users had greater CAC progression (p<0.01), even after adjusting for several covariates.

After excluding people with previous or incident cardiovascular events, frequent statin users still had greater CAC progression (7.1 vs. 4.3 mm3, p=0.03).

In an analysis limited to patients who weren’t using statins at baseline, the more frequent users ended up with greater progression of CAC as well as abdominal aortic calcification, compared to less frequent users.

“We really don’t know if the results of our study translate into reduced cardiovascular events such as heart attacks and strokes or lessening the statins overall benefits,” Dr. Saremi said, adding that calcification might play a role in the healing process of “vulnerable” plaques.

“Statins lower the lipid-rich core of vulnerable plaques, and may lead to increased calcification and density of the plaques and therefore they may contribute to plaque stabilization and fewer cardiovascular events,” she said. “On the other hand, we know people with more vascular calcification are at greater risk of cardiovascular events.”

At this point, however, Dr. Saremi said it’s too early to make any definitive conclusions or change clinical practice.

“Our study is ongoing, and longer follow-up in this group will help determine if increased progression of vascular calcification in statin users is associated with greater or fewer events compared with statin user with less progression or in those who progress without statins,” she said.

SOURCE: http://bit.ly/OEzNj4

Diabetes Care 2012.

Reuters Health Information © 2012