Miriam E. Tucker is a senior writer with Elsevier Global Medical News. Lipoprotein management in patients with cardiometabolic risk is the focus of a new joint consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. The evidence-based statement—written by a seven-member panel following a 3-day consensus conference held last summer—-advises assessing global “cardiometabolic risk” (CMR), followed by a multifactorial risk-reduction strategy that targets individual risk factors with both lifestyle and pharmacologic therapy. Specific recommendations are given for management of dyslipidemia in patients by risk level. The statement was published in the April edition of Diabetes Care (Diabetes Care 2008;31:811-22). Among the clinical entities considered to increase CMR are type 2 diabetes, familial combined hyperlipidemia, familial hypoalphalipoproteinemia, and polycystic ovary syndrome. All share the characteristics of central obesity, insulin resistance, dyslipoproteinemia, and hypertension. For such patients, the panel recommended: ▸ Statin therapy for the majority of dyslipidemic adult patients with CMR. ▸ For patients with CMR on statin therapy, guiding therapy with measurements of apolipoprotein B (apoB) and treatment to apoB goals in addition to LDL-cholesterol and non-HDL cholesterol assessments. ▸ Treatment goals that address the high lifetime risk of patients with cardiometabolic risk and dyslipidemia as follows: For patients with either known cardiovascular disease (CVD) or diabetes plus one or more additional major CVD risk factor, LDL cholesterol should be less than 70 mg/dL, non-HDL cholesterol less than 100 mg/dL, and apoB less than 80 mg/dL. For those who have no diabetes or known clinical CVD risk factors but have two or more additional major CVD risk factors or who have diabetes but no other major CVD risk factors, LDL cholesterol should be less than 100 mg/dL, non-HDL cholesterol less than 130 mg/dL, and apoB less than 90 mg/dL. The panel also recommended clinical trials to determine whether the pharmacologic therapy required to achieve very low levels of atherogenic lipoproteins is safe and cost effective. Further, it advocates for a concerted, multifaceted public health effort, focused on lifestyle modification to reduce mean population levels of atherogenic lipoproteins to values well below current ones. Two of the panelists disclosed no conflicts of interest. The other five each disclosed multiple dualities of interest, including four who had accepted consulting fees/honoraria from Merck & Co, and Schering-Plough Corp., three from Abbott Laboratories and Pfizer Inc., and two from AstraZeneca Pharmaceuticals, Kos Pharmaceuticals, Sanofi-Aventis, and Daiichi-Sankyo. “As with any guidelines that aren't specific to geriatrics and long-term care, these need to be considered cautiously,” commented William Smucker, MD, CMD, of Westfield Center, Ohio. “Elderly patients with cardiovascular disease—as compared to younger adults—gain a much greater absolute risk reduction with treatment in important outcomes such as death, myocardial infarction, and stroke. It also is important to note that elderly do not have a higher risk of adverse effects from statins and the benefits accrue in 12 months or less. “The decision to treat often rests on life expectancy—an estimated life span of a year or more—along with a reasonable quality of life and whether the practitioner, patient, and/or family thinks reducing the risk of adverse outcomes is a goal of therapy.”