Considerations for CVD risk reduction in patients with diabetes and elevated LDL-C

Managing CVD risk in patients with diabetes and elevated LDL-C

Adult patients with diabetes are 3-5 times more likely to have a CV hospital admission and approximately 3–5 times more likely to die from CVD compared to those without diabetes.¹

Cholesterol management is one vital component of a holistic approach to CV risk reduction in diabetes care. When treating patients with diabetes, the greatest reductions in CV risk and mortality are seen with combined long-term risk factor management of blood pressure, HbA1c and lipids.^2,3

In a retrospective outpatient study that looked at 281,381 patients with diabetes in Italy, ≥60% of patients with diabetes with LLT did not reach guideline-recommended LDL-C goals (ESC/EAS 2016-2019), therefore remained at increased risk of CVD.^4,5,*,†

Join leading experts, Dr. Patrick Holmes and Beverley Bostock, as they delve into key considerations for managing hypercholesterolaemia and mixed dyslipidaemia in patients with diabetes, with a focus on reducing their heightened CV risk through effective LLT.

In this video, they review current practices for managing patients with diabetes, address common patient concerns and barriers to initiating LLT, and discuss the available treatment options, highlighting the importance of selecting the right therapy for each patient.

Explore the efficacy data for NUSTENDI® and NILEMDO®.

*Patients receiving combination therapy of statin + ezetimibe (N=4,516).^5
†ESC/EAS 2019 guidance definitions: ^†Very high risk: defined as people with any of the following: documented ASCVD, either clinical or unequivocal on imaging; documented ASCVD includes previous ACS (MI or unstable angina), stable angina, coronary revascularisation (PCI, CABG, and other arterial revascularisation procedures), stroke and TIA, and PAD; unequivocally documented ASCVD on imaging includes those findings that are known to be predictive of clinical events, such as significant plaque on coronary angiography or CT scan (multivessel coronary disease with two major epicardial arteries having >50% stenosis), or on carotid ultrasound; DM with target organ damage,^‡ or at least three major risk factors, or early onset of T1DM of long duration (>20 years); severe CKD (eGFR <30 mL/min/1.73 m²); a calculated SCORE ≥10% for 10-year risk of fatal CVD; FH with ASCVD or with another major risk factor. High risk: defined as people with: markedly elevated single risk factors, in particular total cholesterol >8 mmol/L (>310 mg/dL), LDL-C >4.9 mmol/L (>190 mg/dL), or BP ≥180/110 mmHg; patients with FH without other major risk factors; patients with DM without target organ damage,^‡ with DM duration ≥10 years or another additional risk factor; moderate CKD (eGFR 30–59 mL/min/1.73 m²); a calculated SCORE ≥5% and <10% for 10-year risk of fatal CVD. Moderate risk: defined as young patients (T1DM <35 years; T2DM <50 years) with DM duration <10 years, without other risk-factors; a calculated SCORE ≥1% and <5% for 10-year risk of fatal CVD.^4
‡Target organ damage is defined as microalbuminuria, retinopathy, or neuropathy.⁴

Speaker bios

Dr. Patrick Holmes

Partner Middleton & Dinsdale Medical Practice, Darlington, Director Goggledocs Education Ltd and Darlington PCN diabetes lead

Dr. Holmes has been a GP Partner at St. George’s Medical Practice, Darlington for 22 years. He is a local clinical commissioner for diabetes. Trustee & committee member for the Primary Care Diabetes Society. Primary Care Diabetes NIHR Research lead for the North East. Associate Editor for Diabetic Medicine. He has also worked as a GPwSI in Diabetes for County Durham and Darlington Foundation Trust. Clinical interests – adult type 2 diabetes, cardiovascular disease prevention & chronic kidney disease.

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Beverley Bostock

Advanced Nurse Practitioner in general practice in Gloucestershire and an Editor in Chief of Practice Nurse journal

She qualified as an RGN at St George’s Hospital London and gained a BSc in Professional Nursing Studies after completing 2 years of an advanced clinical practice MSc at Wolverhampton University. She is an Independent Nurse Prescriber and holds a PGDip in Diabetes, an MSc in Respiratory Care and an MA in Medical Ethics and Law. Beverley’s other qualifications include a Post Graduate Award in Diabetes Therapeutics from Warwick University. Beverley has extensive educational experience developing modules in diabetes and CVD for an Open University-affiliated organisation and is an Expert Witness for a clinical negligence company. She has been a Queen’s Nurse since 2015, a title which is given to nurses who have demonstrated a high level of commitment to patient care and nursing practice. Beverley is a President-Elect of the Primary Care Cardiovascular Society and has worked on the Implementation Steering Group of Public Health England’s CVDPREVENT project and Oxford AHSN’s ‘Prevention of CVD during the pandemic’ guidance. She has also been a Visiting Lecturer in behaviour change at Imperial College London for the MSc in Preventive Cardiology.

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