Progression of vascular calcification is increased with statin use in the Veterans Affairs Diabetes Trial (VADT).

Saremi A, Bahn G, Reaven PD; for the VADT Investigators. Progression of vascular calcification is increased with statin use in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care. 2012;35:2390-2392. 

Exclusive! Vivian Fonseca, MD, provides expert commentary on this post-hoc analysis of VADT.
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Background  

Cross-sectional data from the Veterans Affairs Diabetes Trial (VADT) showed that participants with coronary artery or abdominal aortic calcification had an increased prevalence of cardiovascular disease, including peripheral artery disease and coronary artery disease.1 VADT investigated the impact of intensive and standard glucose control on cardiovascular events among military veterans who had a suboptimal response to antihyperglycemic therapy.

Statin therapy may be prescribed for prevention and risk reduction of cardiovascular events in those with type 2 diabetes. In the VADT study cohort, is statin use associated with progression of vascular calcification? In exploring this query, the authors of the present study found that statin use promotes development of coronary artery calcium (CAC) among those with type 2 diabetes and advanced atherosclerosis, even in the presence of efficacious lipid-lowering treatment.

VADT Post-hoc Analysis Design  

Subjects included in this analysis (N=197) were from VADT and had type 2 diabetes and presence of extensive atherosclerosis at baseline. The authors assessed progression of both CAC and abdominal aortic artery calcium (AAC) based on the frequency of statin use in these patients. (Click here for slide.)  

Results  

The majority of subjects using statins (82%; n=161) cited frequent statin use (in >50% of study visits). These subjects had increased prevalence of prior cardiovascular disease compared with less frequent statin users (reported statin use in ≤50% of study visits; n=36; 41% vs 19%; P=0.01). At the end of the study, more frequent statin users had lower levels of total cholesterol, LDL-C, and total cholesterol/HDL-C ratio compared with less frequent users of statins.

Frequency of statin use did not effect cardiovascular disease event incidence. However, more frequent statin use was associated with accelerated progression of coronary artery calcium vs less frequent statin use: 8.2 ± 0.3 mm3 vs 4.2 ± 1.1 mm3 (P<0.01). (Click here for slide.)  

No significant association was seen between more frequent statin use and progression of AAC in the overall study population. When subjects were stratified by baseline statin use, those who were not receiving statins at baseline and subsequently reported frequent statin use had increased progression of both AAC and CAC after adjustment for age and baseline calcium compared with less frequent statin users.

Mean age of study participants was 61 years, and mean duration of type 2 diabetes was 12 years. Baseline statin use in the study cohort was 61% (n=121).

1. Reaven PD, Sacks J. Coronary artery and abdominal aortic calcification are associated with cardiovascular disease in type 2 diabetes. Diabetologia. 2005;48(2):379-385.  

Related content: 

Clinical Insights® in Diabetes :: December 2012  

Slide: VADT: Comparing Intensive With Standard Glucose Therapy, Primary Outcome  

Slide: VADT: Comparing Intensive With Standard Glucose Therapy, Secondary Outcomes  

Slide: VADT: Comparing Intensive With Standard Glucose Therapy, Change in Median A1C  

Slide: VADT: Comparing Intensive With Standard Glucose Therapy, Adverse Events  

Slide: Type 2 Diabetes Therapy and Cardiovascular Events: Comparing VADT With Other Trials  

Expert commentary: Burton E. Sobel, MD, provides expert commentary on the debate over intensive versus somewhat less intensive glycemic control (You must be a registered member of NDEI.org to view.)  

 

December 2012

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

Last Modified: 3/23/2015