Diabetes is NOT a cardiovascular disease equivalent and there is limited data to support the <70 mg/dl target for total cholesterol argued Prof Lawrence Leiter from the University of Toronto at the ADA 2010.

He pointed out that there is no study that set 70mg/dl as the cholesterol target and that this is an extrapolated figure based on several other studies.

He reminded the audience of the abundant data that suggest that diabetes is not a cardiovascular disease equivalent and that patients should have a suitable lipid management strategy based on their current total cardiovascular risk.

He reviewed briefly a 2008 meta-analysis published in the Lancet that demonstrated that people with diabetes derive the same overall risk reduction from cholesterol reduction as people without diabetes.

He also reminded the delegates that data from the NHANES population suggest that it is the presence of metabolic syndrome in additon to diabetes which confers increased cardiovascular risk rather than diabetes per se.

In an amusing aside he quoted a 2008 ADA survey which showed that the American population are more afraid of shark bites than diabetes; with 49% afraid of cancer, 12% heart disease, 11% stroke, 4% shark bites and only 3% fearing diabetes!

In concluding Professor Leiter demonstrated data from Framingham and elsewhere which show that the presence of diabetes causes the risk of heart disease to occur some 15 years earlier than would be the case without diabetes in both men and women. Thus he supported the use of an age of 45 years in men with diabetes and 50 years in women with diabetes to define a high cardiovascular risk that would be the trigger for lipid lowering in the absence of any other significant additional risk factor.