Diabetes: early intervention to lower LDL cholesterol reduces cardiovascular risk

Diabetes is a chronic global condition affecting over half a billion adults worldwide, including around 4 million in Italia. People living with diabetes are at a much higher risk – some studies suggest twice the risk – of developing cardiovascular diseases, such as heart attacks and strokes: this is why risk management requires an increasingly integrated and personalised approach. Accurate identification of a diabetic patient’s risk profile, in fact, enables timely intervention on the main factors contributing to the progression of atherosclerotic disease – including LDL cholesterol – thereby altering the course of cardiovascular risk throughout the disease continuum.

This is confirmed by new scientific evidence, including the results of the Vesalius-CV study presented at the recent American Diabetes Association conference in New Orleans, which show that, in people with diabetes who are at high cardiovascular risk but have not had a heart attack or stroke, intensive reduction in LDL cholesterol with evolocumab in combination with optimised lipid-lowering therapy “is associated with a significant reduction in the risk of experiencing a first major cardiovascular event compared with placebo”.

“The results with evolocumab in this new analysis of the Vesalius-CV study confirm how important it is to correctly assess cardiovascular risk in people with diabetes, even in the absence of a previous event. As LDL cholesterol is the causative factor in atherosclerotic disease, this evidence reinforces the need to identify high-risk patients at an early stage and to intervene effectively to lower LDL levels in order to reduce the likelihood of future cardiovascular events - states Salvatore De Cosmo, director of the Complex Unit of Internal Medicine and Endocrinology at the IRCCS “Casa Sollievo della Sofferenza” in San Giovanni Rotondo (FG) and National President of the Association of Diabetes Specialists (AMD). Since cardiovascular risk depends not only on LDL cholesterol levels but also on the duration of exposure to elevated levels, taking early action with effective therapies such as evolocumab, is crucial to reducing the cumulative burden of LDL cholesterol over the course of a lifetime and helping to alter the course of cardiovascular risk, thereby promoting patients’ future health.”

When it comes to LDL cholesterol, therefore, time is of the essence. Cardiovascular risk depends not only on how high cholesterol levels are, but also on how long our bodies are exposed to them. Atherosclerosis is a process that develops over many years and often shows no symptoms until it manifests as a heart attack or stroke. That is why the real challenge is to stay one step ahead: to identify at an early stage those with diabetes who are most at risk and to intervene promptly to reduce their LDL cholesterol. “Doing so,” continues De Cosmo, “means altering the natural course of the disease and offering patients better long-term cardiovascular protection.” The aim, therefore, is to reduce the risk of cardiovascular events by lowering LDL cholesterol and, where possible, to prevent the first event by investing in the patient’s future health.