ORLANDO, Fla., Nov. 10 /PRNewswire/ -- Lipid management is suboptimal among women with coronary heart disease (CHD) and diabetic women are at heightened risk of not meeting the minimum HDL threshold, according to research presented today at the American Heart Association's Scientific Sessions 2003. The results of the study suggest that physicians of diabetic women with CHD should be more aggressive about treating to goal and that lipid management strategies should be more comprehensive for diabetics.
"Many patients hospitalized with coronary heart disease do not meet national standards for LDL, or 'bad' cholesterol, and just over half are at the triglyceride target," said lead investigator Lori Mosca, M.D., Ph.D., director of preventive cardiology at NewYork-Presbyterian Hospital and associate professor of medicine at Columbia University College of Physicians & Surgeons. "Surprisingly, less than 19 percent had what is considered a protective level of HDL, which is the 'good' cholesterol. Diabetic women were even less likely to meet the minimum standard level than non-diabetics."
While 46 percent of women in the study were taking cholesterol-lowering drugs known as statins, only 41 percent were at an optimal LDL cholesterol level. Minority diabetics were less likely to be at LDL level goal than white diabetics (OR=0.45, p<.05). High levels of LDL cholesterol can build up in the walls of the arteries, causing a narrowing of the arteries known as atherosclerosis. If a clot forms and blocks a narrowed artery, it can cause a heart attack or stroke. A high LDL level reflects an increased risk of heart disease.
Only 19 percent of women had a protective HDL level of >/=60mg/dL. Diabetics were less likely to meet the minimum standard HDL level of >/=40 mg/dL than non-diabetics (OR=0.46, p<0.05, adjusted for age and ethnicity). A low HDL level (<40 mg/dL) is also strongly associated with an increased risk of heart disease. HDL cholesterol protects against heart attack by carrying the "bad" cholesterol away from the arteries and back to the liver. HDL may potentially remove excess cholesterol from plaque in arteries, thus slowing the build-up.
"Low HDL may play just as crucial a role as high LDL in determining a woman's risk for heart disease, so patients need to ask their doctor for all the numbers, not just total cholesterol," said Dr. Mosca. "Women with diabetes have an even more urgent need for concern: the American Diabetes Association recommends that HDL levels for women with diabetes be above 55 mg/DL, which is higher than the National Institutes of Health guidelines for patients without diabetes."
Only 55 percent of all women met the triglyceride goal of <150 mg/dL, and diabetics had higher levels than non-diabetics (184+/-132 vs. 151+/-80, p<0.05). Exercising more than 30 minutes at least three times a week was a significant predictor of being at triglyceride target compared to non- exercisers (OR=2.18, p<0.05).
Study Detail
The study evaluated predictors of the primary LDL goal and secondary lipid thresholds as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines among 304 women hospitalized at three academic medical centers with an acute coronary syndrome, CHD, or a coronary revascularization procedure. Those goals are: total cholesterol <200 mg/dL; LDL cholesterol <100 mg/dL; HDL cholesterol >/=40 mg/dL (protective HDL >/=60 mg/dL); and triglycerides <150 mg/dL. Women were categorized as diabetic if they reported a history of diabetes on a standard questionnaire or if they had a glucose level >/= 126 mg/dL on a preadmission laboratory report.
About Diabetes and Heart Disease
Approximately 17 million people in the United States (6.2 percent of the population) suffer from diabetes, one the of the nation's fastest-growing and deadliest chronic conditions. Diabetes has doubled in prevalence between 1990 and 2000 and is currently the sixth leading cause of death in the U.S. Adults with diabetes are two to four times more likely to develop heart disease than non-diabetic adults, and heart disease is the leading cause of diabetes- related deaths.
Note: Abstract Poster Session (APS.99.1) will be held on Sunday, November 9, 2003 from 8:30 a.m. to 5:00 p.m. Presentation is from 3:00 p.m. to 4:30 p.m.
NewYork-Presbyterian HospitalCONTACT: Public Affairs of NewYork-Presbyterian Hospital,+1-212-305-5587; or Abigail Hecht or Paul Rabin, both of Fleishman-Hillard,+1-212-453-2000, for NewYork-Presbyterian Hospital