Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation.

isk factors for type 2 diabetes and cardiovascular disease CVD) often cluster, including obesity (particularly central), nsulin resistance, hyperglycemia, dyslipoproteinemia, and ypertension. These conditions can also occur in isolation, nd they are exaggerated by physical inactivity and smoking. ince each of these factors increases risk of CVD, the oncept of global cardiometabolic risk (CMR) (Fig. 1) is of alue (1). Lipoprotein abnormalities, including elevated riglycerides, low HDL cholesterol, and increased numbers f small dense LDL particles, are common findings in atients with CMR. Clinical entities with increased CMR nclude type 2 diabetes, familial combined hyperlipidemia, amilial hypoalphalipoproteinemia, and polycystic ovary yndrome (2). These disorders often share the CMR charcteristics of central obesity, insulin resistance, dyslipoproeinemia, and hypertension. There are stringent lipid treatment goals for patients with type 2 diabetes or CVD; however, guidelines for treatment of dyslipoproteinemia in high-risk subjects without diabetes or CVD are less intense and are based primarily on LDL cholesterol concentrations, with non-HDL concentrations a secondary consideration in some subjects. Numerous trials have demonstrated that therapies (primarily statins) directed at LDL cholesterol lowering clearly reduce risk of CVD events in patients with diabetes and in those without diabetes but with other CVD risk factors; yet, a number of questions remain. Even with adequate LDL cholesterol lowering, many patients on statin therapy have significant residual CVD risk. It is unclear whether lipoprotein parameters other than LDL or non-HDL cholesterol provide clinically significant additional prognostic information regarding CVD risk, yield more information about the effec-