Cardiovascular disease (CVD) is the leading cause of death in people with diabetes, making the need to manage risk for CVD among these patients as critical as the need to manage their blood glucose levels. Recognition of this fact has prompted the US National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) to elevate diabetes to the status of a coronary heart disease (CHD) risk equivalent and to call for a more intensive prevention strategy for patients with diabetes.
This publication focuses on the management of dyslipidemia and the metabolic syndrome in preventing CHD in patients with diabetes. Based on proceedings of a roundtable symposium of national authorities on cholesterol management that took place in Baltimore, Maryland, on December 4, 200l, it presents an overview of specific ATP III recommendations and their implications for clinical practice.
In an overview of the new guidelines, Sherita Hill Golden, MD, MHS, an endocrinologist on the faculty of Johns Hopkins University, addresses possibilities for successful implementation of risk-reducing practices in patients with diabetes and possibilities for pharmacologic management of cholesterol. She describes the metabolic consequences of insulin resistance and their implications for cardiovascular health. The mechanisms of atherosclerosis, the primary cause of mortality in people with diabetes, are described in detail, as well as the physiological causes of the high incidence of dyslipidemia in this population. Dr Golden also presents clinical evidence supporting aggressive cholesterol management in patients with diabetes and describes the importance of the metabolic syndrome and lifestyle interventions as well as various pharmacologic approaches to cholesterol management.
In the roundtable discussion and case study that follow, several authorities in the field of dyslipidemia discuss current concepts and some of the key issues involved in the diagnosis and treatment of lipid disorders and glucose intolerance in patients with diabetes. The limitations of low-density lipoprotein cholesterol (LDL-C) as a predictor of treatment success in diabetic patients is discussed, along with the clinical challenges in achieving triglyceride and high-density lipoprotein cholesterol (HDL-C) goals within this population. These experts share their knowledge and experience from clinical practice, including views on how best to achieve lipid and triglyceride goals, the role of apolipoprotein B (apo B) in therapeutic decision making, and the implications of emergent research for practicing physicians.
*Director of Preventive Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
†Professor of Medicine and Pediatrics, Johns Hopkins University School of Medicine; Director, Johns Hopkins University Lipid Clinic; Chief, Lipid Research, Johns Hopkins University Hospital, Baltimore, Maryland.