Lipid-Altering Therapy and Diabetes Mellitus Although secondary subgroup analyses of some studies did not find a benefit of statins in patients with diabetes mellitus,311,312 the Medical Research Council/British Heart Foundation Heart Protection Study (HPS) found that the addition of a statin to existing treatments in high-risk patients resulted in a 24% reduction (95% CI, 19 28) in the rate of major CVD events.313 A 22% reduction (95% CI, 13 30) in major vascular events (regardless of the presence of known coronary heart disease or cholesterol levels) and a 24% reduction (95% CI, 6 39; P=0.01) in strokes were found among 5963 diabetic individu- als treated with the statin in addition to best medical care.314 The Collaborative Atorvastatin Diabetes Study (CARDS) reported that in patients with type 2 diabetes mellitus, at least 1 additional risk factor (retinopathy, albuminuria, current smoking, or hypertension), and an LDL cholesterol level <160 mg/dL but without a history of CVD, treatment with a statin resulted in a 48% reduction (95% CI, 11 69) in stroke.315 In a post hoc analysis of the Treating to New Targets (TNT) study, the effects of intensive lowering of LDL cholesterol with high-dose (80 mg daily) versus low-dose (10 mg daily) atorvastatin on CVD events were compared for patients with coronary heart disease and diabetes mellitus.316 After a median follow-up of 4.9 years, higher-dose treatment was associated with a 40% reduction in the time to a CVD event (HR, 0.69; 95% CI, 0.48 0.98; P=0.037). Clinical trials with a statin or any other single intervention in patients with high CVD risk, including the presence of dia- betes mellitus, are often insufficiently powered to determine an effect on incident stroke. 