The new clinical practice guideline for the treatment of blood cholesterol released jointly by the American College of Cardiology (ACC) and American Heart Association (AHA) was a key topic for debate during the American Diabetes Association 74th Scientific Sessions. Robert H. Eckel, MD and Henry Ginsberg, MD provided their points of view concerning the appropriateness of the guideline in the treatment of patients with diabetes. It should be noted that Dr. Eckel was involved in the development of the ACC/AHA guidelines and Dr. Ginsberg was not.
About the ACC/AHA Guideline
The guideline does not set specific target levels for lowering cholesterol. It only recommends moderate- or high-intensity statin therapy for four groups:
Patients with …
“We have four statin treatment groups that are recommended for statin therapy; three of them relate to diabetes: people with existing atherosclerosis with diabetes; people with diabetes who, in fact, have diabetes without known cardiovascular disease; and possibly a low-risk patient with diabetes,” stated Dr. Eckel. He pointed out that LDL and non-high-density lipoprotein (non-HDL) treatment goals were not included in the guideline, which is problematic.
However, that does not mean those goals can’t be utilized in practice. Dr. Eckel recommended, “A physician can make a decision to set levels that they feel comfortable with based on reading the guidelines and having an educated knowledge of patients.” Dr. Eckel’s viewpoint is “almost [word requires clarification] all people with diabetes should be on a statin.”
Dr. Ginsberg favored treatment according to an individual’s risk profile. “Where I have my largest issue is not so much in using LDL, but in not going beyond statins when needed,” stated Dr. Ginsberg. Furthermore, he said, “My criticism focuses on the LDL and lack of LDL goals or lack of being able to add something on top of a statin to lower LDL.”
The ADA recommends, “People with diabetes keep LDL cholesterol levels at or below 100 mg/dL, or under 70 mg/Dl if they also have cardiovascular disease. The Association also recommends using high-dose statin therapy to reach those goals.”