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The Challenge of Achieving National Cholesterol Goals in Patients With Diabetes

¹ Division of General Internal Medicine, Burlington, Vermont
² Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont

Address correspondence and reprint requests to Amanda G. Kennedy, Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl St., Burlington, VT 05401. E-mail: amanda.kennedy{at}vtmednet.org

OBJECTIVE—This 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.

RESEARCH DESIGN AND METHODS—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.

RESULTS—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.

CONCLUSIONS—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.

Abbreviations: CVD, cardiovascular disease • NCEP, National Cholesterol Education Program • NHANES, National Health and Nutrition Examination Survey • VDIS, Vermont Diabetes Information System

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