Risk of coronary events in Japanese patients with both hypercholesterolemia and type 2 diabetes mellitus on low-dose simvastatin therapy: Implication from Japan Lipid Intervention Trial (J-LIT)


      Hypercholesterolemic patients with type 2 diabetes mellitus are at increased risk of coronary heart disease (CHD); however, direct evidence is very limited in Japanese patients. The J-LIT is the first nationwide study conducted to assess the relationship between serum lipid levels and development of coronary events in Japanese hypercholesterolemic patients. We analyzed the coronary events in the J-LIT study subjects by having type 2 diabetes or not. Of the total 41,801 subjects without prior CHD who received open-label simvastatin, 5 mg/day, 6554 (male 40.2%, age 57.8 ± 7.8) subjects had type 2 diabetes, while 35,247 (male 30.0%, age 57.8 ± 7.9) did not.
      In this analysis, relative coronary event risks based on a 0.26 mmol/l (10 mg/dl) increase in low density lipoprotein-cholesterol (LDL-C), were similar between hypercholesterolemic subjects with and without type 2 diabetes (17.3% versus 19.4%). Although all subjects were treated with simvastatin, the subjects with type 2 diabetes have significantly more coronary events compared to the subjects without type 2 diabetes (1.80/1000 and 0.76/1000 patient-years, respectively). Given the results above, to reduce the risk of coronary events in Japanese patients with both hypercholesterolemia and type 2 diabetes, careful and strict cholesterol management is needed in addition to the control of blood glucose.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • National Cholesterol Education Program
        Second report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel II).
        Circulation. 1994; 89: 1333-1445
        • Castelli W.P.
        • Garrison R.J.
        • Wilson P.W.
        • et al.
        Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study.
        JAMA. 1986; 256: 2835-2838
        • Stamler J.
        • Wentworth D.
        • Neaton J.D.
        Is the relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT).
        JAMA. 1986; 256: 2823-2828
        • Keys A.
        • Menotti A.
        • Aravanis C.
        • et al.
        The Seven Countries Study 2,289 deaths in 15 years.
        Prev Med. 1984; 2: 141-154
        • Pedersen T.R.
        • et al.
        Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).
        Lancet. 1994; 344: 1383-1389
        • Sacks F.M.
        • Pfeffer M.A.
        • Moye L.A.
        • et al.
        The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.
        N Engl J Med. 1996; 335: 1001-1009
        • Matsuzaki M.
        • et al.
        A large scale cohort study on the relationship between serum cholesterol levels and coronary events in Japanese patients with hypercholesterolemia: Japan Lipid Intervention Trial (J-LIT)—primary prevention study.
        Circ J. 2002; 66: 1087-1095
        • Horiuchi H.
        • et al.
        Primary cardiovascular events and serum lipid levels in elderly Japanese with hypercholesterolemia under 6-year simvastatin treatment: a sub-analysis of the J-LIT Study.
        J Am Geriatr Soc. 2004; 52: 1981-1987
        • Kodama K.
        • Sasaki H.
        • Shimizu Y.
        Trend of coronary heart disease and its relationship to risk factors in a Japanese population: a 26-year follow-up. Hiroshima/Nagasaki study.
        Jpn Circ J. 1990; 54: 414-421
        • Wakugami K.
        • Iseki K.
        • Kimura Y.
        • et al.
        Relationship between serum cholesterol and the risk of acute myocardial infarction in a screened cohort in Okinawa, Japan.
        Jpn Circ J. 1998; 62: 7-14
        • Okayama A.
        • Ueshima H.
        • Marmot M.G.
        • et al.
        Changes in total serum cholesterol and other risk factors for cardiovascular disease in Japan 1980–1989.
        Int J Epidemiol. 1993; 22: 1038-1047
        • Investigating Committee on Guidelines for Diagnosis Treatment of Hyperlipidemias Japan, Atherosclerosis Society
        Guidelines for diagnosis and treatment of hyperlipidemias in adults.
        Jpn J Atheroscler. 1997; 25: 1-34
        • Kawamori R.
        Diabetes trends in Japan.
        Diabetes Metab Res Rev. 2002; 18: S9-S13
        • Gotto A.M.
        Lipid management in diabetic patients: lessons from prevention trials.
        Am J Med. 2002; 112: 19S-26S
        • Matsuzawa Y.
        • Itakura H.
        • Kita T.
        • et al.
        Design and baseline characteristics of a cohort study in Japanese patients with hypercholesterolemia: The Japan Lipid Intervention Trial (J-LIT).
        Curr Therapeu Res. 2000; 61: 219-243
        • Cox D.R.
        Regression models and life tables (with discussion).
        J R Stat Soc. 1972; B34: 187-220
        • Matsuzawa Y.
        • et al.
        Sustained reduction of serum cholesterol in low-dose 6-year simvastatin treatment with minimum side effects in 51,321 Japanese hypercholesterolemic patients: implication of the J-LIT study, a large scale nationwide cohort study.
        Circ J. 2003; 67: 287-294
        • Rubins H.B.
        • et al.
        Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high density lipoprotein cholesterol.
        N Engl J Med. 1999; 341: 410-418