Lipid and blood pressure control reduce CVD risk
Question: Should patients with type 2 diabetes be treated more aggressively for hyperlipidemia and hypertension than nondiabetic patients?
Answer: It is well known that patients with type 2 diabetes have a much higher risk for heart attack or stroke than people without diabetes. Reasons include the effects of increased blood glucose levels on cholesterol particles; low levels of HDL cholesterol and smaller, more dangerous LDL cholesterol particles; increased risk of blood clotting in the arteries of the heart and brain; high blood pressure; greater inflammation of the blood vessels; and abnormalities in the lining of the arteries.
The American Diabetes Association (ADA) and the National Cholesterol Education Program put patients with diabetes in a higher-risk group, meaning that their cholesterol targets should be lower than those in individuals without diabetes.1
Fortunately, we can do something. Studies show that lowering cholesterol levels lessens the risk of heart disease in patients with diabetes.2,3 For most patients, this means taking a statin. In fact, nearly all patients with type 2 diabetes will benefit from a statin, even if their LDL level isn't particularly high.4,5
The ADA recommends that all people older than 40 with a total cholesterol level >135 mg/dl should be started on a statin, with a goal of a 30% to 40% reduction in LDL cholesterol (regardless of initial LDL) and a target LDL of <100 mg/dl. For patients with type 2 diabetes and overt cardiovascular disease, a target LDL level of <70 mg/dl is recommended.6
Patients with diabetes also are vulnerable to changes in blood pressure levels, particularly in terms of heart attack, kidney failure, and stroke. The ADA recommends keeping blood pressure below 130/80 mmHg.6 Angiotensin converting enzyme (ACE)-inhibitors and angiotensin receptor blockers (ARBs) lower the risk for heart attack, kidney damage, and death in addition to lowering blood pressure.7,8 Even patients with normal blood pressure who are at increased risk for heart attack or kidney disease should be on an ACE-inhibitor and/or an ARB.9 ▪
Footnotes
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Do you have a clinical question? Send it to docnews{at}diabetes.org.
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Anne Peters Harmel, MD, is a professor of medicine at the University of Southern California's Keck School of Medicine, director of the USC Westside Center for Diabetes, and director of the Comprehensive Diabetes Center at Roybal Community Medical Center.
- American Diabetes Association, Inc.
