• Under lång tid har frågan kring statinbehandling av typ 1-diabetes diskuterats, här kommer med artikeln mer kött på benen
• En synnerligen elegant studie, fortfarande saknas en större RCT med statin och T1DM.
• Det viktigaste i sammanhanget är sannolikt sjukdomsdurationen, men vi vet inte riktigt hur data kommer att se ut i den era vi lever i nu med CGM och semiautomatiska pumpar
– och en betydligt bättre glykemisk kontroll.
• Studien stärker användandet av statiner vid T1D.
Safety and Effectiveness of Statins
for Primary Prevention in Adults
With Type 1 Diabetes. JACC
JACC. 2025;86:797–809
Joseph Edgar Blais, PHD,a,* Vincent Ka Chun Yan, PHD,a,* Esther Wai Yin Chan, PHD,a,b,c,d
Ian Chi Kei Wong, PHD,b,e,f,g Eric Yuk Fai Wan, PHDa,
Läs artikeln
https://www.jacc.org/doi/10.1016/j.jacc.2025.07.013
ABSTRACT
BACKGROUND
There is no consensus for using statins for primary prevention of cardiovascular disease (CVD) and
all-cause mortality in adults with type 1 diabetes mellitus (T1DM), because no randomized controlled trial has
exclusively investigated statins in this population.
OBJECTIVES
In this study, the authors sought to evaluate the long-term risks and benefits of statins for primary
prevention in adults with T1DM.
METHODS
We performed a sequential target trial emulation comparing statin initiation vs noninitiation using UK
primary care data from the IQVIA Medical Research Data database.
Persons aged 25 to 84 years with a diagnosis record of T1DM with prescription of insulin from January 2005 to December 2016
were included if they had baseline low-density
lipoprotein-cholesterol (LDL-C) $2.6 mmol/L (100 mg/dL) or non-high-density lipoprotein cholesterol $3.4 mmol/L
(130 mg/dL).
Persons with preexisting coronary artery disease, myocardial infarction, stroke, heart failure, myopathy, liver
disease, rheumatic heart disease, schizophrenia or cancer were excluded.
Main outcome measures were all-cause mortality,
major CVD and adverse events (myopathy and liver dysfunction). We estimated 10-year absolute risk differences (RDs) for
the observational analogues of the intention-to-treat (ITT) and per-protocol (PP) effects.
RESULTS
We included 4,176 statin initiator (mean age of 45 years, 33.1% <40 years, 40.6% female) and 16,704
noninitiator person-trials with median follow-up of 6 years.
Compared with noninitiation, statins were associated with
reductions in all-cause mortality (RDITT: 1.66% [95% CI: 2.79% to 0.45%]; RDPP: 3.48% [95% CI: 4.68%
to 2.07%]) and major CVD (RDITT: 1.63% [95% CI: 2.57% to 0.53%]; RDPP: 2.69% [95% CI: 4.00%
to 1.22%]).
Some analyses suggested a slight association with increased risk of liver dysfunction but no association
with myopathy. In subgroup analyses, absolute risk reductions were generally larger in women, persons $40 years of
age, persons with baseline LDL-C $3.4 mmol/L (130 mg/dL), and persons with a higher predicted cardiovascular risk.
CONCLUSIONS
Among adults with T1DM, statin initiation for primary prevention was associated with reductions in
all-cause mortality and major CVD with a very low risk of adverse effects.
The differences in absolute risk reductions can
help guide personalized statin treatment decisions in T1DM.
From the Conclusion
CONCLUSIONS
The results of this study have important implications
for the care of adults with T1DM.
• First, the estimates
can be used to inform recommendations in clinical
practice guidelines for prescribing statins for primary
prevention in adults with T1DM who have subop-
timal LDL-C or non-HDL-C.
• This additional evi-
dence to support statin initiation could facilitate
individualized statin therapy, which has the po-
tential to contribute to enhanced reductions in CVD
events at the population level.
• Second, clinicians
and patients can use the absolute risks, and corre-
sponding number needed to treat/number needed
to harm, to make evidence-informed decisions
about the appropriate time to initiate a statin for a
specific patient, considering patient preferences
and values for statin use and CVD risk reduction.
• Third, our study demonstrates the large absolute
benefits of statin initiation, particularly in women
with T1DM, an important group that has long been
known to have a higher burden of CVD.
• This ev-
idence could support sex-specific recommendations
and make statins a higher-priority intervention for
women with T1DM and suboptimal atherogenic
cholesterol.
In summary, in this target trial emulation of adults
with T1DM and suboptimal LDL-C or non-HDL-C
statin use was consistent with reductions in all-cause
mortality and major CVD, with no consistent increase
in liver dysfunction or myopathy.
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Läs Medicinsk kommentar i Läkartidningen
Svenska vuxna patienter med T1DM underbehandlas. Medicinsk kommentar. Läkartidningen
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