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Aggressively Reducing Cardiac Risk Factors - Is it Truly Beneficial for Diabetes Patients?
Almost all treatment guidelines for patients with diabetes suggest aggressively treating high low-density lipoprotein (LDL or "bad" cholesterol) and blood pressure levels to reduce patients’ risk of developing heart disease, according to background information in the article. "These recommendations, which are based on the average results of trials evaluating the relative benefits of intensive risk factor control, are not tailored to an individual’s underlying cardiovascular disease risk," the authors write. "While this [risk stratification] approach is often advocated in patients without diabetes mellitus, there is an implicit assumption that all patients with diabetes mellitus are at equally high risk, requiring all patients to be treated aggressively."
Justin W. Timbie, Ph.D., of RAND Corp., Arlington, Va., and colleagues constructed a mathematical model to assess whether aggressive treatment would equally benefit all patients with diabetes. They began with data from 30- to 75-year-old participants in the National Health and Nutrition Examination Survey, which provided representative estimates for the nearly 8 million individuals with diabetes in the 1990s. At this time, aggressive cholesterol and blood pressure treatment was uncommon. After excluding participants with low LDL levels and low blood pressure, the average LDL-C level was 151 milligrams per deciliter and the average blood pressure was 144/79 millimeters of mercury.
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