Outcomes/Effectiveness Research

It will be difficult to achieve strict cholesterol goals in many patients with diabetes and cardiovascular disease

Cholesterol management with diet and/or lipid-lowering medications such as statins is essential in the preventive care of patients with diabetes who are at high risk for cardiovascular disease (CVD). New National Cholesterol Education Program guidelines recommend a low density lipoprotein (LDL) cholesterol goal of less than 70 mg/dl for patients at very high risk for CVD, which includes patients with established CVD plus one or more problems such as diabetes or acute coronary syndromes.

To attain this goal, about 25 percent of patients with diabetes and CVD will need two lipid-lowering drugs at maximal dosage, notes Amanda G. Kennedy, Pharm.D., B.C.P.S., of the University of Vermont College of Medicine. In a study supported in part by the Agency for Healthcare Research and Quality (HS13891), researchers categorized primary care patients with diabetes into high-risk and very-high-risk cardiovascular status and examined their lipid profiles and medications. They then assessed the required changes in therapy to achieve the LDL goal for patients not yet at the goal.

Overall, about 30 percent of patients said they had known CVD, placing them in the very-high-risk category. Of the entire group of 650 patients, about half were already taking lipid-lowering medication, and 49 percent had LDL less than 100 mg/dl, the target LDL for high-risk patients. However, only 16 percent of those at very high risk for CVD had an LDL less than 70 mg/dl. Based on best-case scenarios, the researchers estimated that nearly 4 percent of high-risk patients would require more than two lipid-lowering drugs to achieve an LDL less than 100 mg/dl, and 26 percent of the very-high-risk group would not reach an LDL less than 70 mg/dl with two lipid-lowering medications.

More details are in "The challenge of achieving national cholesterol goals in patients with diabetes," by Dr. Kennedy, Charles D. MacLean, M.D., Benjamin Littenberg, M.D., and others, in the May 2005 Diabetes Care 28(5), pp. 1029-1934.

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