To achieve the LDL cholesterol target, a blood level of 70, "I would still consider using ezetimibe [a second-line, cholesterol-lowering drug] in people who cannot tolerate statins and people who cannot achieve the target with maximum doses of statins or other medication," Roman said.
And while the incidence of side effects was higher in those treated aggressively for high blood pressure, Roman said, "aiming for that target has a beneficial effect. It is always easy to back off and not be as aggressive."
There was some disagreement on aggressive treatment of high blood pressure from Dr. Eric D. Peterson, a professor of medicine at Duke University, and author of an accompanying editorial.
"It would seem, based on what we have here, hard to justify ultraintensive hypertension reduction when we haven't shown benefit from a clinical viewpoint," Peterson said.
But with LDL cholesterol, "many arguments can be made for aggressive treatment in diabetic populations," he said.
The side effects of aggressive LDL cholesterol-lowering treatment are "minimal," Peterson said, and the addition of ezetimibe (Zetia) to statin treatment in some cases "seems to be reasonable."
"But ezetimibe has been a second-line agent," he said. "I would never use it as a first-line agent."
Ezetimibe has also been the subject of controversy in recent months as trials have started to show that adding the drug to statin treatment produces no benefit in reducing plaque build-up in blood vessels.
The links between diabetes and heart disease are outlined by the American Diabetes Association.
SOURCES: Barbara V. Howard, Ph.D., senior
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