Medical Device Daily Executive Editor

SAN DIEGO – Various new markers of cardiovascular disease (CVD) risk are helping clinicians assess such risk in their patients.

Their use is proving particularly important for CVD risk assessment in diabetic patients, according to reports presented at this week’s annual scientific sessions of the American Diabetes Association (ADA; Alexandria, Virginia).

During a symposium that focused on non-traditional cardiovascular risk factors, Lewis Kuller, MD, professor of epidemiology at the University of Pittsburgh, said electron-beam computed tomography (EBCT) measurement of coronary artery calcium (CAC) is a valuable marker of sub-clinical atherosclerosis.

Coronary calcium scores in diabetics increase markedly, he said, in those with impaired glucose tolerance, with a score above 100 serving as strong predictor of CVD risk.

The higher the CAC score in diabetics, the higher the mortality risk, Kuller said, citing “a direct linear relationship” as a predictor of mortality. He noted that the rates of atherosclerosis rise with age.

Ronald Krauss, MD, director of atherosclerosis research at Children’s Hospital Oakland Research Institute (Oakland, California), cited low-density lipoprotein (LDL, the so-called “bad” cholesterol) as a risk factor for CVD, saying it had been slowly emerging in that role over the past two decades.

He said that small LDL particles – LDL-3 or LDL-4, which also are the most common – are much more capable of inducing atherosclerosis than large- (LDL-1) or medium-sized (LDL-2) particles. He added that high levels of triglycerides have been shown to produce smaller LDL and high-density lipoprotein (LDL, or “good” cholesterol) particles.

Krauss cited studies showing that diabetics with a larger concentration of small LDL particles than larger particles have a risk of cardiovascular disease triple that of those without such concentration.

Measuring LDL particles and reducing small particles with therapeutics can reduce the progression of coronary artery disease, he said.

The usefulness of C-reactive protein (CRP) as part of overall CVD risk assessment for patients was discussed by Christie Ballantyne, MD, director of the Center for Cardiovascular Disease Prevention at the Baylor College of Medicine (Houston).

Noting that CRP is “the best-studied marker for CVD,” he said that increased levels of CRP are indicative of a doubled risk for stroke.

Also during the ADA meeting, Medtronic (Minneapolis) reported the results of a company-supported health analysis that said the U.S. economy could save up to $72 billion if Americans kept their blood glucose levels in line with current treatment guidelines.

Guidelines recommended by the ADA and American Association of Clinical Endocrinology (Jacksonville, Florida) call for diabetic patients to maintain A1c (a test that measures average blood glucose over a two- to three-month period) levels at below 7% and 6.5%, respectively.

The health analysis reported by Medtronic said that lowering A1c levels to the recommended levels would save between $35 billion and $50 billion indirect medical costs over a 10-year period, with indirect costs, such as lost work time or disability, bringing that figure to between $50 billion and $72 billion.

The predictive analysis is part of the Center for Outcomes Research Diabetes Model, which projects costs and outcomes for diabetes patients based on data from major clinical and epidemiological studies.

Michael Minshall, director of the Switzerland-based center’s U.S. unit, said tighter control of A1c would make an “enormous difference” in the life of diabetes patients.

Another CORE Diabetes Model analysis reported at the ADA meeting, this one based on Swiss data, projected that insulin pump therapy could increase life expectancy for Type 1 diabetics by 10 months, compared to those who have multiple daily injections of insulin, and could reduce lifetime treatment costs by some $8,400.

“This analysis indicates that pump therapy can reduce the potentially debilitating or fatal side effects of diabetes,” said Andrew Palmer, MD, medical director of CORE. He added that use of an insulin pump “[improves] blood sugar control and . . . quality of life.”