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Lipid-lowering medication should be considered early in treatment of blacks with diabetes and high LDL cholesterol levels

People who have diabetes are at higher risk than those without diabetes for cardiovascular disease (CVD), probably due in part to elevated blood lipids. Also, CVD-related deaths are higher among people with diabetes, especially blacks, than among other patients.

A recent study of urban blacks (mean age of 57 years) with type-2 (adult-onset) diabetes and LDL cholesterol levels above clinically recommended targets found that neither improved blood-sugar (HbA1c) control nor weight loss alone was sufficient to affect LDL cholesterol levels, but adding lipid-lowering medication was effective. Doctors should strongly consider using lipid-lowering medications early in the course of diabetes management for blacks with diabetes who have high LDL cholesterol levels to reduce their risk of cardiovascular complications, according to the researchers who conducted the study.

With support from the Agency for Healthcare Research and Quality (HS09722), they analyzed initial and 1-year followup lipid values among 345 predominantly black and overweight patients at an urban outpatient diabetes clinic. The subjects had an initial average LDL cholesterol level of 140 mg/dl (recommended level is less than 130 mg/dl). They examined the independent effects of lipid-specific medications, glycemic (blood-sugar) control, and weight loss on serum total cholesterol, LDL ("bad") cholesterol, HDL ("good") cholesterol, and triglyceride levels.

Patients who lost more than 1 kg of weight did not have significantly decreased LDL cholesterol. The mean HbA1c levels of the 243 patients not taking lipid-lowering medication declined significantly compared with the initial visit (9.2 to 8.2 percent; 7 percent is the target level). However, total cholesterol, LDL cholesterol, and triglyceride concentrations remained about the same (208 vs. 210 mg/dl, 138 vs. 137 mg/dl, and 141 vs. 140 mg/dl, respectively). The 102 patients who received lipid-lowering medications reduced their HbA1c levels (9.8 to 8.2), as well as total cholesterol (247 to 219), LDL cholesterol (174 to 145 mg/dl), and triglycerides (164 to 146 mg/dl). HDL cholesterol levels stayed about the same in both groups (50 mg/dl).

See "The impact of outpatient diabetes management on serum lipids in urban African-Americans with type 2 diabetes," by Diane M. Erdman, Pharm.D., Curtiss B. Cook, M.D., Kurt J. Greenlund, Ph.D., and others, in the January 2002 Diabetes Care 25(1), pp. 9-15.

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