PMID- 21076630
OWN - NLM
STAT- MEDLINE
DCOM- 20110712
LR  - 20211020
IS  - 1933-2874 (Print)
IS  - 1876-4789 (Linking)
VI  - 4
IP  - 5
DP  - 2010 Sep-Oct
TI  - Achieving lipid targets in adults with type 2 diabetes: the Stop Atherosclerosis 
      in Native Diabetics Study.
PG  - 435-43
LID - 10.1016/j.jacl.2010.07.007 [doi]
AB  - BACKGROUND: Although lipid management in diabetes is standard practice, goals 
      often are neither met nor maintained. Strategies for achieving lower targets have 
      not been explored. The Stop Atherosclerosis in Native Diabetics Study randomized 
      patients with diabetes to standard versus aggressive lipid and blood pressure 
      goals for 36 months. OBJECTIVE: To report strategies used to achieve and maintain 
      lipid goals and to report adverse events (AEs). METHODS: Adults with type 2 
      diabetes and no history of cardiovascular disease (N = 499) were randomized to 
      standard (low-density lipoprotein cholesterol [LDL-C] </= 100 mg/dL, 
      non-high-density lipoprotein cholesterol [non-HDL-C] </= 130 mg/dL) or aggressive 
      (LDL-C </= 70 mg/dL, non-HDL-C </= 100 mg/dL) targets. An algorithm was started with 
      statin monotherapy, with intestinally acting agents added as required to reach 
      LDL-C targets.Triglyceride [TG]-lowering agents were next used to reach non-HDL-C 
      goals. Lipid management was performed by mid-level practitioners, with physician 
      consultation, by the use of point-of-care lipid determinations. RESULTS: On 
      average, both groups achieved the LDL-C and non-HDL-C goals within 12 months and 
      maintained them throughout the study. At 36 months, mean (SD) LDL-C and non-HDL-C 
      were 72 (24) and 102 (29) mg/dL in the aggressive group (AGG) and 104 (20) and 
      138 (26) mg/dL, respectively, in the standard group (STD); systolic blood 
      pressure targets were 115 and 130 mmHg, respectively. A total of 68% of 
      participants reached target LDL-C for greater than 50% of the visits and 46% for 
      greater than 75% of visits. At 36 months, the AGG averaged 1.5 lipid lowering 
      medications and the STD 1.2. Statins were used in 91% and 68% of the AGG and STD; 
      ezetimibe by 31% and 10%; fibrates by 8% and 18%. No serious AEs were observed; 
      AEs occurred in 18% of the AGG and 14% of the STD. CONCLUSION: Standard and 
      aggressive lipid targets can be safely maintained in diabetic patients. 
      Standardized algorithms, point-of-care lipid testing, and nonphysician providers 
      facilitate care delivery.
CI  - (c) 2010 National Lipid Association. All rights reserved.
FAU - Russell, Marie
AU  - Russell M
AD  - Phoenix Indian Medical Center, Phoenix, AZ, USA.
FAU - Silverman, Angela
AU  - Silverman A
FAU - Fleg, Jerome L
AU  - Fleg JL
FAU - Lee, Elisa T
AU  - Lee ET
FAU - Mete, Mihriye
AU  - Mete M
FAU - Weir, Matthew
AU  - Weir M
FAU - Wilson, Charlton
AU  - Wilson C
FAU - Yeh, Fawn
AU  - Yeh F
FAU - Howard, Barbara V
AU  - Howard BV
FAU - Howard, W M James
AU  - Howard WM
LA  - eng
GR  - U01 HL067031/HL/NHLBI NIH HHS/United States
GR  - U01 HL067031-04S1/HL/NHLBI NIH HHS/United States
GR  - U01-HL067031/HL/NHLBI NIH HHS/United States
GR  - U01 HL067031-02/HL/NHLBI NIH HHS/United States
GR  - U01 HL067031-05S2/HL/NHLBI NIH HHS/United States
GR  - U01 HL067031-05S1/HL/NHLBI NIH HHS/United States
GR  - U01 HL067031-05/HL/NHLBI NIH HHS/United States
GR  - U01 HL067031-01A1/HL/NHLBI NIH HHS/United States
GR  - U01 HL067031-03/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - J Clin Lipidol
JT  - Journal of clinical lipidology
JID - 101300157
RN  - 0 (Anticholesteremic Agents)
RN  - 0 (Azetidines)
RN  - 0 (Cholesterol, LDL)
RN  - 0 (Fibric Acids)
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - EOR26LQQ24 (Ezetimibe)
SB  - IM
MH  - Adult
MH  - Anticholesteremic Agents/therapeutic use
MH  - Atherosclerosis/prevention & control
MH  - Azetidines/therapeutic use
MH  - Cardiovascular Diseases/*prevention & control
MH  - Cholesterol, LDL/blood
MH  - Diabetes Mellitus, Type 2/*blood/physiopathology
MH  - Ezetimibe
MH  - Female
MH  - Fibric Acids/therapeutic use
MH  - Humans
MH  - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
MH  - Male
MH  - Middle Aged
PMC - PMC2976563
MID - NIHMS226130
OTO - NOTNLM
OT  - American Indians
OT  - blood pressure
OT  - cardiovascular disease
OT  - carotid artery intima media thickness
OT  - lipids
COIS- Conflicts of interest: Dr. B.V. Howard has served on the advisory boards of 
      Merck/Schering Plough and has received research support from Merck/Schering 
      Plough. Dr. Wm. J. Howard has received research support as part of multicenter 
      trials from Pfizer, Astra Zeneca, Merck, and Schering Plough; has served as a 
      consultant for Merck, Schering Plough, and Pfizer; and has served on the 
      speaker's bureau for Merck, Schering Plough, Pfizer, Astra Zeneca, Abbott, and 
      Daiichi Sankyo. The other authors have nothing to declare.
EDAT- 2010/11/16 06:00
MHDA- 2011/07/13 06:00
PMCR- 2011/09/01
CRDT- 2010/11/16 06:00
PHST- 2010/11/16 06:00 [entrez]
PHST- 2010/11/16 06:00 [pubmed]
PHST- 2011/07/13 06:00 [medline]
PHST- 2011/09/01 00:00 [pmc-release]
AID - S1933-2874(10)00238-2 [pii]
AID - 10.1016/j.jacl.2010.07.007 [doi]
PST - ppublish
SO  - J Clin Lipidol. 2010 Sep-Oct;4(5):435-43. doi: 10.1016/j.jacl.2010.07.007.