European Heart Journal Advance Access originally published online on September 5, 2006
European Heart Journal 2006 27(19):2323-2329; doi:10.1093/eurheartj/ehl220
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Acute coronary syndromes and diabetes: is intensive lipid lowering beneficial? Results of the PROVE IT-TIMI 22 trial
The TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, First Floor, Boston, MA 02115, USA
Received 12 February 2006; revised 11 August 2006; accepted 17 August 2006; online publish-ahead-of-print 5 September 2006.
* Corresponding author. Tel: +1 617 278 0146; fax: +1 888 249 5261. E-mail address: cpcannon{at}partners.org
Aims The impact of intensive lipid lowering therapy with statins in acute coronary syndrome (ACS) patients with diabetes mellitus (DM) is not well characterized.
Methods and results We explored this question in data from the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT) TIMI 22 trial, which tested standard (pravastatin 40 mg) vs. intensive (atorvastatin 80 mg) statin therapy among patients treated early in the post-ACS period. We compared outcomes between patients with DM (identified by history, fasting plasma glucose 
126 mg/dL or haemoglobin A1C>7%; n=978) against those without DM (n=3184). The rate of acute cardiac events (death, myocardial infarction, and unstable angina requiring rehospitalization) was much higher in patients with DM, but was reduced with intensive vs. standard therapy similarly in diabetic (21.1 vs. 26.6%, HR=0.75, P=0.03) and non-diabetic patients (14.0 vs. 18.0%, HR=0.76, P=0.002); P-interaction=0.97. Despite intensive therapy, the majority of diabetics (62%) did not reach the dual goal of LDL-C<70 mg/dL and high-sensitivity C-reactive protein <2 mg/L.
Conclusion In ACS patients with DM, intensive statin therapy reduces acute cardiac events as it does in those without DM, with 55 vs. 40 events prevented per 1000 patients treated. However, our data highlight the need for additional strategies in this high-risk group.
Key Words: Diabetes mellitus • Acute coronary syndromes • Lipid lowering • Inflammation
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