Tackling stroke and heart risks.

Lowering cholesterol concentration in diabetes patients can prevent heart attacks and strokes, even in those who have acceptable cholesterol numbers and no history of heart problems, a new study finds.

People with diabetes have an increased risk of heart disease, but many doctors hesitate to prescribe cholesterol-lowering drugs for people with normal or borderline cholesterol, says Helen M. Colhoun of University College Dublin in Ireland.

To assess the benefits of using a cholesterol-lowering statin drug in people who have diabetes, researchers gave a small dose of atorvastatin (Lipitor) each day to 1,428 patients, while 1,410 similar patients received an inert pill. All the patients had type 2, or adult-onset, diabetes. Most members of both groups initially had near-normal scores for low-density lipoprotein (LDL) cholesterol, the harmful kind.

After 4 years of this regimen, LDL concentrations had dropped by roughly 40 percent in those getting atorvastatin, whereas LDL levels in the placebo group remained steady. Over this period, 33 of the patients receiving atorvastatin had heart attacks, of which 8 were fatal. Those getting the inert pills suffered 61 heart attacks, 20 of them fatal. Moreover, the statin group had about half as many strokes as the placebo group did, says Colhoun.

Recent studies have suggested that any lowering of LDL protects against heart disease. Although further studies will be needed to solidify the benefit of statins for people with diabetes, Calhoun says, "The challenge would be to see if you can identify anybody with diabetes who shouldn't [receive them]."--N. S.