Heart attack in diabetics: Cholesterol reduction limits risk of recurrence

Lowering cholesterol levels in people with diabetes after a heart attack would reduce the risk of a new accident.

Diabetes patients are twice as likely to have a stroke, heart attack or stroke. A study by researchers at Imperial College London and published in Lancet Diabetes and Endocrinology demonstrates that regular injections of a drug other than statins that reduce the level of bad cholesterol, the inhibitor of PCSK9, a drug administered by injection that blocks the action of a key enzyme in the liver, could lower the risk of recurrence for those who have already had a heart attack.

An inhibitor of PCSK9 instead of statins

These results come from a trial of 19,000 cardiovascular patients who were already taking high doses of statins to lower their cholesterol levels. These patients, recruited in 57 countries, were classified into three groups: diabetic, pre-diabetic and having a normal blood sugar level. All these patients had been hospitalized after a cardiovascular event. They were given instead of their high-dose statins either aliroculab (PCSK9 inhibitor) or placebo every two weeks.

Four months after the start of the trial, the levels of bad cholesterol (LDL) in patients taking alirocumab were reduced to an average of 0.8 mmol / L compared to those taking placebo who had LDL of 2.25 mmol / L. After a follow-up of 2.8 years, the team found that in the most exposed diabetics, treatment with alirocumab reduced the risk of an additional cardiovascular event by 2.3% on average.

Effective but expensive injections

Conclusion: Diabetes patients, who account for one third of cardiovascular accident victims, would benefit from this injectable treatment, which greatly reduces cholesterol levels. A population whose identification is all the more important that, compared to a treatment with cholesterol by statins, the PCSK9 inhibitors are expensive.

"These shots are effective but expensive, so we need to consider targeting them in patients with diabetes for whom the risk of heart attack is twice as high," says Prof. Kausik Ray, chairholder in public health at Imperial College London.

Video: Treating Low Blood Sugar. Hypoglycemia. Nucleus Health (December 2019).