The ADA has defined "low-risk" (<100 mg/dl, 2.60 mmol/L), "borderline" (100-129 mg/dl, 2.60-3.35 mmol/L), and "high-risk" (>130 mg/dl, >3.38 mmol/L) LDL levels for adults. The goal for LDL in adults with diabetes is less than 100 mg/dl (<2.60 mmol/L). Similarly, levels of risk have been defined for HDL cholesterol. In men, "high-risk" is less tiian 35 mg/dl (<0.90 mmol/L), "borderline risk" 35-45 mg/dl (0.90-1.15 mmol/L), and "low-risk" more than 45 mg/dl (>1.15 mmol/L). For women, these values are increased by 10 mg/ dl. The HDL goal is more than 45 mg/dl (>1.15 mmol/L) for men with diabetes and more than 55 mg/dl (>1.40 mmol/L) for women. In regard to plasma triglycerides, "high-risk" is greater than or equal to 400 mg/dl (&4.50 mmol/L), "borderline risk" 200-399 mg/dl (2.30-4.50 mmol/L), and "low-risk" less than 200
mg/dJ (<2.30 mmol/L). The goal for triglycerides in individuals with diabetes is less than 200 mg/dl (<2.30 mmol/L).
In children with risk factors for cardiovascular disease (e.g., diabetes), the goal for total cholesterol is less than 170 (4.4 mmol/L) and for LDL less than 110 mg/dl (<2.80 mmol/L). There are no stated guidelines for HDL or triglycerides in this population (4).
Comment: Recently published guidelines from the National Cholesterol Education Program (NCEP) state that the goal for LDL should be based on the patient's prior history of a significant cardiovascular event or the presence of defined risk factors for coronary disease (5). Previously, diabetes was simply considered a risk factor with the same relative weight as such other factors as family history of heart disease, smoking, hypertension, and gender. Recent studies have suggested that having diabetes confers a risk of cardiovascular disease equal to that of having had a previous cardiovascular event (6). In the 2001 NCEP guidelines, diabetes is considered a "CHD risk equivalent," and the LDL goal when diabetes is present is less than 100 mg/dl.
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