Introduction

The management of cardiovascular risk is a huge area for debate, involving a multitude of factors, disciplines and guidelines. The Cardiodiabetes Forum, sponsored by MSD Ltd and Schering-Plough Ltd, was a multidisciplinary meeting of diabetologists, cardiologists, and clinicians with particular interest in lipid and cardiovascular disease management who came together at the Royal College of Physicians in London to discuss some of the current hot topics in cardiovascular risk management in a series of five ‘round table’ style debates. Each debate was led by a member of the faculty; areas for consideration included the translation of cholesterol guidelines into practice, the use of new and existing surrogate markers, the management of risk in ‘at-risk’ populations and the need for a more collaborative approach in the management of diabetic patients with cardiovascular disease. Each group had a series of questions to address to give the debate some structure, but the content and areas discussed were largely dictated by the participants.

The subject matter of these debates has become even more topical recently with publication of the National Institute for Health and Clinical Excellence (NICE) Guidelines on the Management of Type 2 Diabetes¹ and Lipid Modification.² The consensus reached at the meeting is broadly in line with these guidelines. In particular, NICE recommends the use of lipid-lowering therapy in type 2 diabetic

patients over the age of 40 with normal to high cardiovascular risk (or under 40 with a poor cardiovascular risk profile), aiming for a total cholesterol level below 4.0 mmol/L or low-density lipoprotein cholesterol (LDL-C) level below 2.0 mmol/L.¹ Lipid-lowering therapy for primary prevention of cardiovascular disease (CVD) in non-diabetics is recommended for adults who have a 20% or greater 10-year risk of developing CVD, although there is no target level for total or LDL cholesterol. Targets are recommended for secondary prevention patients and it is suggested that an ‘audit’ level of total cholesterol of 5.0 mmol/L is used since fewer than half will achieve total cholesterol below 4.0 mmol/L or LDL-C below 2.0 mmol/L.²

The main points from each debate, plus consideration of the wider implications for practice, are summarised within this supplement.

Martin Bennett
Chairman, Professor of Cardiovascular Sciences, Addenbrooke’s Hospital, Cambridge.

Faculty members

Martin Bennett
Chairman, Professor of Cardiovascular Sciences, Addenbrooke’s Hospital, Cambridge.

Professor Mike Kirby,
GP and Visiting Professor, University of Hertfordshire.

Dr Kausik Ray,
Senior Clinical Research Associate, University of Cambridge and Consultant Cardiologist, Addenbrooke’s Hospital, Cambridge.

Dr Doug Robertson,
Consultant Endocrinologist, Sandwell General Hospital.

Dr Clive Weston,
Consultant Cardiologist, Singleton Hospital,
Swansea.

References

1. National Institute for Health and Clinical Excellence. Clinical guideline 66. Type 2 diabetes: the management of type 2 diabetes (update). London, May 2008. www.nice.org.uk/CG066
2. National Institute for Health and Clinical Excellence. Clinical guideline 67. Lipid modification: cardiovascular risk assessment and the primary and secondary prevention of cardiovascular disease in England. London, May 2008. www.nice.org.uk/CG067