Patients with cardiometabolic risk (CMR) factors such as lipoprotein abnormalities -- including elevated triglycerides, low HDL cholesterol and increased numbers of small dense LDL particles -- are at high risk of developing cardiovascular disease (CVD) and require aggressive management, according to a consensus statement from the American Diabetes Association and the American College of Cardiology Foundation published in the April issue of Diabetes Care.

John D. Brunzell, M.D., of the University of Washington in Seattle, and other expert panel members developed a consensus position that addressed five questions relating to patients with CMR: "To what extent do lipoproteins contribute to CVD? What are the clinically important lipoprotein parameters? In the evaluation and treatment of patients with lipoprotein abnormalities, are there other factors that should be considered? What are the principles and objectives of treatment of lipoprotein abnormalities? What new information would help improve lipoprotein management?"

The panel advised clinicians to assess patients' global risk and adopt a multi-factorial risk reduction strategy that targets each risk with lifestyle changes and/or medication.

"In terms of dyslipoproteinemia, we recommend the following: Statin therapy for the majority of dyslipoproteinemic adult patients with CMR. For patients with CMR on statin therapy, guiding therapy with measurements of apoB and treatment to apoB goals in addition to LDL cholesterol and non-HDL cholesterol assessments. Treatment goals…that address the high lifetime risk of patients with dyslipoproteinemia and CMR. Clinical trials to determine whether the pharmacologic therapy required to achieve very low levels of atherogenic lipoproteins is safe and cost-effective. A concerted, multifaceted, public health effort, focused on lifestyle modification, to reduce mean population levels of atherogenic lipoproteins to values well below current ones," the authors conclude.

Several panel members disclosed financial ties to pharmaceutical companies.

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Prepared jointly by the editors of RN and HealthDay's Physicians' Briefing (www.physiciansbriefing.com).