Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo

Abstract Number : 74
Diabetic atherosclerosis: the need for aggressive lipid-lowering treatment

Stefano Del Prato, Department of Endocrinology and Metabolism, Section of Diabetes and Metabolic Diseases, University of Pisa, 
Italy

Diabetes is likely to represent a major health challenge in the next future. By the year 2025, there will be more than 300 millions of people suffering of diabetes, most of them affected by Type 2 diabetes. This epidemic will be associated with an exponential increase in long-term complications. Early recognition of diabetic individuals and appropriate treatment will be required in the attempt to reduce the burden of diabetic complications. In the UKPDS intensive glycemic control was associated with a significant 25% reduction in microvascular complications. Though a relationship between updated HbA1c and cardiovascular events was an apparent, high level of LDL- and low concentrations of HDL-cholesterol ranked as the main risk factors for cardiovascular events. In the same trial cardiovascular disease accounted for 59% of deaths. Moreover, recent data suggest individuals with diabetes who have not had a previous myocardial infarction have the same risk of having one within the next 7 years as individuals without diabetes who have had a previous myocardial infarction. Thus, adequate attention has to be paid to lipid lowering in order to relieve the burden of cardiovascular risk in Type 2 diabetic patients. In these individuals, low-HDL cholesterol, high serum VLDL-triglycerides, and a preponderance of small and dense LDL particle characterize dyslipidemia. Even moderate elevations of LDL-cholesterol in Type 2 diabetes confer quite an atherosclerotic risk. At any cholesterol level, patients with diabetes have a two to four time’s greater mortality than individuals without diabetes. Lipid lowering have shown to reduce morbidity and mortality in these patients. The 4S, CARE LIPID and more recently the Heart Protection Study has documented clear advantages of statin use in diabetic patients. A 25% reduction in the cardiovascular event incidence has been found in the over 4000 diabetic patients with no previous history of cardiovascular disease. All these studies, however, were not specifically designed to assess the effect of lipid lowering in the diabetic population, but even stronger information will be generated by ongoing studies. In the Lipids in Diabetes Study both statin and fibrate will be employed in order to assess the reduction of cardiovascular mortality in 5000 patients with Type 2 diabetes. In the US, the Atorvastatin Study for the Prevention of coronary heart disease Endpoints (ASPEN) will compare double-blind treatment with Atorvastatin and placebo, while a sister trial, the Collaborative Atorvastatin Diabetes Study (CARDS) will be carried out in the UK. In the meantime, guidelines from medical organisations suggest that patient with LDL-cholesterol ≥130 mg/dl, and perhaps even those with levels ≥100 mg/dl should receive drug therapy. Optimal LDL-cholesterol has been set at ≤100 mg/dl and ≤115 mg/dl for high-risk patients by European guidelines and US respectively. However, it should not be forgotten that Type 2 diabetes, in particular, is a typical metabolic disease characterised by concomitant multiple risk factors. The importance of targeted, intensified, long-term intervention aimed at multiple risk factors in Type 2 diabetic patients has been recently shown to reduce cardiovascular and microvascular events by half. 

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