Optimizing Lipid Management in Patients with Multiple Risk Factors
The Association of Black Cardiologists, Inc (ABC) is committed to maintaining and increasing knowledge, skills, and professional performance in the area of cardiovascular medicine and its related risk factors. To this end, ABC has sponsored an educational activity (supported in part by an educational grant from AstraZeneca) entitled .1
This program focused particularly on patients with diabetes and metabolic syndrome, and was designed to improve cardiovascular disease (CVD) outcomes through optimal management of coronary heart disease (CHD) risk factors. Special emphasis was placed on lipid lowering in African American patients with multiple risk factors, including dyslipidemia, hypertension, and diabetes. The burden of CVD and CHD risk in African Americans warrants more effectively achieving recommended treatment goals, and this can be fostered through improved provider communication regarding treatment goals and their importance to patients.
How large is the burden of diabetes? It is alarming that over past decades in which heart disease and stroke have continued to decline, diabetes prevalence has soared.2 From 1980 through 2004, the number of Americans with diabetes more than doubled (from 5.8 million to 14.7 million). In 2005, the prevalence of diabetes in the United States for all ages was 20.8 million people, or 7.0% of the population (14.6 million diagnosed cases and another 6.2 million undiagnosed). In 2005, 1.5 million new cases of diabetes were diagnosed in people aged 20 years or older.3
Furthermore, ethnic minorities are especially affected by diabetes and are at particularly high risk. The total prevalence of diabetes among people aged 20 years or older among non-Hispanic whites is 13.1 million (8.7%); for non-Hispanic blacks the number is 3.2 million (13.3%). After adjusting for population age differences, Mexican Americans, the largest Hispanic/Latino subgroup, are 1.7 times as likely to have diabetes as non-Hispanic whites. Moreover, 12.8% of American Indians and Alaska Natives had diagnosed diabetes. The total prevalence of diabetes (both diagnosed and undiagnosed) is not available for Asian Americans or Pacific Islanders. In Hawaii, however, Asians, Native Hawaiians, and other Pacific Islanders aged 20 years or older are more than 2 times as likely to have diagnosed diabetes as whites after adjusting for population age differences.
For those affected by diabetes, the complications associated with the disease are significant and serious. Heart disease and stroke account for about 65% of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes, and the risk for stroke is 2 to 4 times higher among people with diabetes.3 About 73% of adults with diabetes have blood pressure ≥130/80 mm Hg or use prescription medications for hypertension. Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years. Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2002. More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
Standards of Medical Care in Diabetes—2006
It is clear that for both diabetes and related medical conditions, both caregiving and general awareness need to be improved. To that end, the American Diabetes Association released a position statement in January 2006 on the .4 The standards addressed diabetes care, treatment goals, and tools to evaluate the quality of care, and included diagnostic and therapeutic options known or believed to favorably affect health outcomes of individuals with diabetes. To effectively prevent the ravages of CVD in persons with diabetes, overall preventive efforts as well as multifactorial management must be used. We cannot overstate the importance of identifying and treating prediabetes, hypertension, dyslipidemia, and obesity in managing diabetes. As pointed out by the National Diabetes Education Program (NDEP), comprehensive and ongoing diabetes care can control and/or prevent related macrovascular complications (eg, heart disease, stroke, and circulatory problems) and microvascular complications (eg, blindness, amputations, and end-stage renal disease). To reinforce this message, the NDEP offers 7 evidence-based principles describing essential components of quality diabetes care.5
The ABC will continue to focus on diabetes, including employing the latest epidemiology data, new therapeutic approaches to medication, and lifestyle modification. In addition, ABC educational activities will continue in the fall of 2006.
The author acknowledges technical support provided by Maleeka Glover, ScD, MPH, Senior Research Scientist Officer, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and editorial support by L. Neicey Johnson, Vice-President Public Affairs, ABC.