MIGHT A STATIN-ORIENTED STRATEGY BE COUNTERPRODUCTIVE IN THE TREATMENT OF DIABETES MELLITUS? Dear Sir,

Estimates of global diabetes mellitus prevalence indicate that the number of people with diabetes mellitus, a pathology closely related to unhealthy lifestyles, is projected to increase from 246 million to up to 380 million by 2025.(1) On the basis of these projections, it is unrealistic to imagine that one can prevent or treat the overt clinical complications in a vastly expanding diabetes population merely by means of drugs: it is therefore imperative that a serious battle against this pandemia should mainly rely on lifestyle modifications, in particular, physical exercise. A recent and well-publicised meta-analysis by the Cholesterol Treatment Trialists ’ Collaborators suggested that statin therapy should be considered for all people with diabetes mellitus, irrespective of whether vascular disease has developed and irrespective of lipid profile.(2) However, it was disturbing that the authors of this meta-analysis neither mentioned nor considered the role of physical activity in the prevention and management of diabetes mellitus. Indeed, patients enrolled in all randomised trials included in the meta-analysis(2) were not given any advice to exercise. Low cardiorespiratory fitness and physical inactivity are independent predictors of all-cause cardiovascular disease mortality in individuals with type 2 diabetes mellitus.(3) Furthermore, it has been reported that a steep inverse gradient exists between fitness and mortality in diabetic patients;(4) this association was independent of body mass index, thus suggesting that the intrinsic benefits associated with increased cardiorespiratory fitness are independent of weight. On the other hand, it is well known that statins may interfere with the ability of patients to exercise.(5