Richard C Oâ??Brien
University of Melbourne, Australia
Keynote: J Diabetes Metab
Lipid lowering therapy, particularly with statins, is a powerful tool to reduce cardiovascular (CV) risk in people with diabetes. However, controversy exists as to exactly who should be treated, and how aggressively. The 2017 Australian Diabetes Society Lipid Guidelines recommend treatment for high risk individuals regardless of baseline LDL cholesterol (LDL), and calculation of absolute risk, with an adjustment based on presence of micro-vascular complications, for those not obviously at high risk. Statins are recommended for all patients with established CV disease (CVD), and in those with significant risk factors such as renal impairment. In patients without CVD, treatment is recommended if 5 year CV risk is â?¥10%. High intensity statin is recommended for patients with existing CVD or high risk (â?¥15%), and moderate intensity statin for risk 10-15%. LDL should be reduced by â?¥50% and to a target of <1.8 mmol/L for high risk; and by â?¥30% with a target of <2.0 mmol/L for moderate risk patients. Ezetimibe is recommended if targets are not reached. Elevation of triglycerides, especially with low HDL-cholesterol, is associated with increased CV risk even when LDL controlled, and fibrates can reduce risk in that setting. Fenofibrate does not interact with statins, and may be added to statin therapy where LDL is at target but triglycerides are â?¥2.3 mmol/L and HDL is low (<1.0 mmol/L male; <1.29 mmol/L female). Fenofibrate has been shown to reduce the development of diabetic retinopathy, even in people with normal triglycerides, and should be initiated in all type 2 diabetic patients with existing retinopathy.
Richard C O’Brien is the Clinical Dean of Medicine at the University of Melbourne. He is the Director of the Lipid Service and a Senior Endocrinologist at Austin Health in Melbourne. Over the last 20 years, his research work has focused mainly on atherosclerosis and diabetes, lipid abnormalities and endothelial dysfunction and has authored over 70 scientific papers on these subjects. He is currently the Chair of the Australian Diabetes Society Expert Committee on Hyperlipidemia and is a past President of the Australian Atherosclerosis Society.
Email: robrien@unimelb.edu.au
