Lower Cholesterol Targets Recommended for Diabetic Patients

New lipid targets of 78mg/dl (2.0 mmol/L)set out by the Canadian Diabetes Association (CDA) reflect more recent evidence from clinical trials and will affect the rates of cardiovascular disease in diabetic patients In a key change, the CDA recommends that patients with diabetes be treated to achieve a low-density lipoprotein cholesterol (LDL-C) level of 78mg/dl or 2.0 mmol/L or less, a decrease from the previous recommendation of 97.5mg/dl or 2.5 mmol/L.

Presented here recently at the annual meeting of the CDA and the Canadian Society for Endocrinology and Metabolism, the new targets are part of the larger set of clinical practice guidelines that are under revision and will be published in their entirety in 2008. The Canadian Cardiovascular Society is also releasing revised lipid targets, largely harmonized with the CDA’s guidelines.

“Since 2003, there have been a number of significant major intervention trials that have also demonstrated that LDL cholesterol is the most important cholesterol in terms of overall benefit in reducing risk of morbidity and mortality by obtaining lower levels for cardiovascular disease even from the previously established levels, which were 97.5mg/dl (2.5 mmol/L) for LDL and a ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL) of 156mg/dl (4.0mmol/L) [or less],” said Dr. Harris, in an interview here at the annual meeting and professional conference of the CDA and the Canadian Society of Endocrinology and Metabolism.

Dr. Harris cited the Collaborative Atorvastatin Diabetes Study (CARDS) and the Treating to New Targets (TNT) trial as supplying conclusive evidence of the benefit of a decreased LDL-C level.

The TNT trial found that both the relative and absolute risk of current coronary or cerebrovascular events in patients with established coronary heart disease were significantly reduced with increased dosage of lipid-lowering drugs, suggesting more aggressive cholesterol reduction is justified in patients with established coronary disease.

“We know that up to 80% of patients with diabetes will die prematurely of cardiovascular disease. This is an opportunity to reduce the impact of morbidity and mortality in the face of a diabetic epidemic. There was some sense of urgency that we need to redefine the target levels.”

The new CDA lipid targets have also placed less importance on the TC/HDL ratio, which was suggested to be 156mg/dl (4.0 mmol/L) or lower in the 2003 CDA guidelines.

Can J Diabetes. 2006;30:230-240
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DID YOU KNOW:
Moderate Drinking Helps the Heart: Moderate drinking of half a drink to two drinks a day — may cut a healthy man’s heart attack risk. That news appears in the Archives of Internal Medicine. It is based on a 16-year study that looked at the habits of 8,800 male health professionals. The findings show that men who reported drinking half a drink to two drinks daily were least likely to have had heart attacks. "Our results suggest that moderate drinking could be viewed as a complement, rather than an alternative, to the other lifestyle interventions," write the researchers. Archives of Internal Medicine, Oct. 23, 2006; vol 166: pp 2145-2150.

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