Optimizing treatment reduces CVD risk in patients with diabetes

Physicians should assess patients on an individualized basis.

CHICAGO — When choosing treatment options for patients with diabetes, physicians should consider factors including diabetes duration, social status, comorbidities and life expectancy, Cindy Lamendola, MSN, ANP, research coordinator at Stanford University School of Medicine, said today at the American College of Cardiology Scientific Sessions.

Factors to consider are hypertension; dyslipidemia; prothrombosis; smoking; physical inactivity and obesity; LDL and HDL goals and triglycerides; patient age; history of hypoglycemia or hypoglycemia unawareness; functional status and cognitive function, Lamendola said.

"LDL goals should be less than 100 mg/dL, but consider a more stringent goal of less than 70 mg/dL for patients with overt CVD, and to achieve an LDL goal, use a statin," she said. “Begin a dose that is going to give you at least a 40% reduction, and if not at target goal, increase the statin or add combination therapy."

She said HDL goals should be greater than 40 mg/dL for men and greater than 50 mg/dL for women, and triglycerides should be less than 150 mg/dL.

The scientific evidence supports the use of aspirin for prothrombosis, according to Lamendola. "For a decrease in MI of 30% and a 20% decrease of cardiovascular events, the first line of treatment is aspirin with a dose of 75 mg to 162 mg," she said. If a patient is at risk for bleeds or allergic to aspirin, consider alternatives, such as clopidogrel (Plavix, Sanofi Aventis), she added.

"Health care professionals should be involved in the identification and assessment of CVD risk factors and initiate a treatment incorporating both lifestyle interventions and pharmacotherapy to get the patient to goal," Lamendola said. – by Christen Haigh

For More Information:

Lamendola, C. Optimizing CVD risk reduction in patients with diabetes. Session 21; ACC 57th Annual Scientific Session; March 29-April 1, 2008.