The Challenge of Achieving National Cholesterol Goals in Patients With Diabetes

Very difficult in many patients with diabetes and cardiovascular disease, to attain an LDL goal of <70 mg/dl. The study analyzed lipid results from a large community-based population of patients with diabetes to assess the feasibility of attaining the standard and new optional LDL-based lipid goals using currently available lipid-lowering medications.

Ambulatory patients with diabetes who were interviewed as part of the Vermont Diabetes Information System trial with a reported LDL were analyzed. Patients were categorized into high-risk and very-high-risk cardiovascular status. For patients not at the LDL goal, the required changes in therapy to achieve the goal were assessed.

The results showed that, of the entire cohort, 49.4% (321 of 650) had LDL <100 mg/dl. According to the National Cholesterol Education Program, 29.4% (191 of 650) of patients were very high risk and have an optional LDL goal of <70 mg/dl. Only 15.7% (30 of 191) of very-high-risk patients had an LDL <70 mg/dl. Based on our analysis of high-risk patients, 17 of 459 (3.7%) would require more than two lipid-lowering drugs to achieve an LDL <100 mg/dl. In the very-high-risk group, we estimate that 26.2% (50 of 191) of patients will not reach LDL <70 mg/dl with two lipid-lowering medications.

From the results, it was concluded that in many patients with diabetes and cardiovascular disease, it will be difficult to attain an LDL goal of <70 mg/dl. Approximately 25% of patients will require more than two lipid-lowering drugs at maximal doses to attain this goal, assuming 100% tolerance of lipid-lowering medications.
Diabetes Care 28:1029-1034, 2005

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DID YOU KNOW:
Are There Benefits to Vitamin E Supplements? Although data suggest that vitamin E supplementation may help prevent cancer and cardiovascular events, international trial results suggest long-term supplementation may not prevent these disorders in patients with vascular disease or diabetes. In fact, researchers concluded long-term vitamin E supplementation “may increase the risk for heart failure.”

Lead investigator Eva Lonn, MD, and colleagues provided daily vitamin E (400 IU) or a matching placebo to about 2,000 patients with vascular disease or diabetes (55 and older) and followed-up with them for a median of seven years. Primary analysis of the study data revealed no differences in outcomes between the vitamin E and the placebo groups: 11.6% of patients receiving vitamin E supplements developed cancer compared with 12.3% for the placebo group; 3.3% versus 3.7% of patients died from cancer in respective comparison. The authors did, however, find that patients in the vitamin E group had about a 13% higher risk of heart failure and 21% higher risk of hospitalization for the condition when compared with the placebo group, although these results were borderline significant. The study was published in the March 16, 2005 JAMA.