The challenge of achieving national cholesterol goals in patients with diabetes.
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.


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.
Kennedy
Amanda G
AG
Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl Street, Burlington, VT 05401, USA. amanda.kennedy@vtmednet.org
MacLean
Charles D
CD
Littenberg
Benjamin
B
Ades
Philip A
PA
Pinckney
Richard G
RG
D000293:Adolescent; D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D006040:Goals; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012307:Risk Factors
D008078:Cholesterol, LDL; D018680:Cholinergic Antagonists