ADA, ACC issue consensus statement on cardiometabolic risk

The American Diabetes Association and the American College of Cardiology released a consensus statement on recommendations for patients with cardiometabolic risk. The consensus statement was published in the April issue of Diabetes Care.

The ADA and ACC convened at a consensus development conference July 18 to July 20, 2007 that focused on lipoprotein management in patients with cardiometabolic risk. A seven-member panel of experts in endocrinology and metabolism, cardiology, epidemiology and public health developed the consensus position.

“Patients with cardiometabolic risk factors represent a group at high lifetime risk for cardiovascular disease; these patients frequently have dyslipoproteinemia,” the panel members wrote. “We recommend an assessment of global risk followed by a multifactorial risk reduction strategy for such individuals targeting each risk factor and emphasizing both lifestyle and pharmacologic therapy.”

The panel members offered the following recommendations in regard to dyslipoproteinemia:

• Statin therapy for most adult patients with cardiometabolic risk.
• If at cardiometabolic risk and receiving statin therapy, guiding therapy with measurements of apolipoprotein B and treatment to ApoB goals in addition to LDL cholesterol and non-HDL cholesterol assessments.
• Treatment goals addressing high lifetime risk in patients with dyslipoproteinemia and cardiometabolic risk.
• Clinical trials to determine safety and cost efficiency of pharmacologic therapy required to achieve low levels of atherogenic lipoproteins.
• A multifaceted public health effort, focused on lifestyle modification, to reduce mean levels of atherogenic proteins in the population.

"Clinicians should achieve optimal LDL cholesterol levels (with statin) using the lipid profile and acknowledge that many of these patients may have optimal LDL cholesterol levels but not optimal treatment due to excess LDL particles,” Robert S. Rosenson, MD, who presented at the consensus panel meeting, told Endocrine Today.

Rosenson is director of lipoprotein disorders and clinical atherosclerosis research at the University of Michigan School of Medicine in Ann Arbor.

Measure ApoB or LDL particle number

A more appropriate way to evaluate cardiometabolic risk and determine the adequacy of LDL-lowering therapies as compared with traditional measures is to measure ApoB or LDL particle number by nuclear magnetic resonance, according to a press release.

“Several studies have shown that LDL cholesterol poorly characterizes lipid abnormalities in patients with cardiometabolic risk,” Rosenson said in a press release. “We have demonstrated that cardiovascular risk associations obtained from LDL particle concentrations compared with LDL cholesterol and non-HDL cholesterol have been shown to be stronger predictors of cardiovascular risk.” – by Christen Haigh

Editor's note: Dr. Rosenson is a paid consultant for and stockholder in LipoScience.

It is important to have risk prediction studies with actual events, and it would be ideal to have some data on how this test would benefit patients and affect outcomes. Our recent experience with the ENHANCE trial has taught us that measuring LDL cholesterol levels is not enough to predict clinical effect, and it is important to understand if this nuclear magnetic resonance test of particle number would lead to patient benefit.

– Rita F. Redberg, MD, MSc, FACC

Professor of Medicine
UCSF School of Medicine, San Francisco

Recommended treatment goals in patients with cardiometabolic risk and lipoprotein abnormalities

	Highest-risk patients: Known CVD or diabetes plus >1 additional major CVD risk factor	High-risk patients:No diabetes or known CVD but >2 additional major CVD risk factors or diabetes with no other CVD risk factors
LDL cholesterol	<70 mg/dL	<100 mg/dL
Non-HDL cholesterol	<100 mg/dL	<130 mg/dL
ApoB	<80 mg/dL	<90 mg/dL

For more information:

• Brunzell JD, Davidson M, Furberg CD, et al. Lipoprotein management in patients with cardiometabolic risk. Diabetes Care. 2008;31:811-822.