Lipid Lowering, Hypertensive Management Targeted in Diabetics

Increasing clinical evidence has demonstrated that aggressive lipid lowering and rigorous hypertensive management in diabetic patients yields significant cardiovascular benefits.

“The recent publication of updated National Cholesterol Education Program (NCEP) guidelines in Circulation, and the publication of the MRC/BHF Heart Protection Collaborative Group in Lancet, underscores the particular benefits of statin therapy on the prevention of cardiovascular events in high- risk groups,” says Perry J. Weinstock, M.D., director of clinical cardiology at Cooper University Hospital. “The NCEP guidelines were supported by the National Heart, Lung, and Blood Institute (NHLBI), the American Heart Association, and the American College of Cardiology. Clinical study results showed a clear mandate to support aggressive lipid lowering in a population that includes millions of diabetic patients,” he added.

More Benefits of LDL Lowering

The Lancet study, which involved daily administration of 40 mg of simvastatin versus placebo, demonstrated that lowering lipid levels in participants with diabetes mellitus reduced the rate for first coronary events by nearly one-quarter, 22%. These benefits were shown regardless of the individual LDL concentration.

“The traditional goal of treatment has been to titrate statin therapy to achieve an LDL of less than 100mg/dL,” says Dr. Weinstock. “These study findings demonstrated the cardiovascular benefit of LDL reduction with statins regardless of the baseline LDL level, and have resulted in a re-evaluation of treatment regimes for this high-risk population,” added Dr. Weinstock. “Accordingly, the new guidelines suggest LDL lowering to under 70mg/dL for this high-risk group.”

Further Study

The Cooper Heart Institute is also a participant in a double-blind, randomized clinical trial being conducted in 80 centers to evaluate the effect of pioglitazone treatment, a glucose-lowering agent, on coronary artery disease. The study entitled PERISCOPE will utilize intravascular ultrasound (IVUS) to examine the progression or regression of coronary artery plaque over an 18-month period. The study is under the direction of Cooper interventional cardiologist Elias Iliadis, M.D.

Hypertension Adds Significant Risk

Aggressive management of blood pressure and glucose levels has also repeatedly shown a reduction in the rate of cardiovascular events in diabetic patients. “Hypertension and increased serum glucose levels decrease endothelial function in both the large coronary arteries and the microvasculature,” says Steven Hollenberg, M.D., director of the Cooper University Hospital Coronary Care Unit and a prolific basic science researcher.

The clinical manifestation of this process, and the link between hypertension, diabetes and cardiac events was demonstrated in the results of the Hypertension Optimal Treatment (HOT) Trial. In the HOT trial, significant risk reduction was demonstrated in major cardiac events, MI’s and stroke when targeted blood pressures were achieved in a study sub-set of diabetic patients.

For more information on cardiovascular issues in diabetes mellitus, or to refer a patient, please call: (856) 342-2034.