Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates.
Sultan Qaboos University Hospital, Muscat, Oman.
Curr Vasc Pharmacol. 2018;16(4):368-375. doi: 10.2174/1570161115666170705153815.
Dyslipidaemia is a risk factor for macrovascular complications in patients with type 2 diabetes mellitus (T2DM). Our aim was to assess the use of lipid lowering drugs (LLDs) in patients with T2DM and co-existing dyslipidaemia.
A multicentre, non-interventional survey conducted in 6 Middle Eastern countries (Bahrain, Oman, Qatar, United Arab Emirates, Kingdom of Saudi Arabia and Kuwait). Patients with T2DM (n = 3338) taking LLD treatment for ≥3 months with no dose change for ≥6 weeks were enrolled.
The mean age (SD) of T2DM patients was 56.6 ±10.6 years; the majority (99%) were on statin monotherapy. Only 48% of these patients achieved their low density lipoprotein cholesterol (LDL-C) goal and 67.7% of the patients had a high cardiovascular disease (CVD) risk according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines. Of those who achieved LDL-C goals (n=1589), approximately one-third were at very high CVD risk and the patients who had received statin monotherapy showed the highest proportion in LDL-C goal attainment, followed by those treated with fibrate monotherapy. In a multivariate logistic regression model, taking drugs daily (odds ratio, OR: 1.64, 95% CI 1.25, 2.15) and older age (OR: 1.09, 95% CI 1.01, 1.18) were significantly associated with better odds of attaining LDL-C target. In contrast, patients with higher levels of ApoA1 (OR: 0.73, 95% CI [0.67,0.79]), Metabolic Syndrome (OR: 0.64, 95% CI [0.53, 0.76]), higher CV risk (OR: 0.33, 95% CI 0.27, 0.41), those who forgot to take their medication (OR: 0.74, 95% CI 0.62,0.88) and those who stopped taking medication when cholesterol became normal (OR: 0.67, 95% CI 0.55,0.82) were significantly associated with lower odds of attaining LDL-C target.
The results of this study highlight the suboptimal management of dyslipidaemia in T2DM patients at high and very high risk of CVD.
血脂异常是 2 型糖尿病（T2DM）患者发生大血管并发症的一个危险因素。我们的目的是评估同时患有血脂异常的 T2DM 患者使用降脂药物（LLD）的情况。
这是一项在 6 个中东国家（巴林、阿曼、卡塔尔、阿拉伯联合酋长国、沙特阿拉伯和科威特）进行的多中心、非干预性调查。共纳入 3338 例接受 LLD 治疗且治疗时间≥3 个月且治疗剂量≥6 周的 T2DM 患者。
T2DM 患者的平均年龄（SD）为 56.6±10.6 岁；大多数（99%）接受他汀类药物单药治疗。根据国家胆固醇教育计划（NCEP）成人治疗专家组（ATP）III 指南，仅有 48%的患者达到了低密度脂蛋白胆固醇（LDL-C）目标，67.7%的患者有高心血管疾病（CVD）风险。在达到 LDL-C 目标的患者中（n=1589），约三分之一患者 CVD 风险极高，接受他汀类药物单药治疗的患者 LDL-C 达标比例最高，其次是接受贝特类药物单药治疗的患者。多变量 logistic 回归模型显示，每日服药（比值比，OR：1.64，95%置信区间 1.252.15）和年龄较大（OR：1.09，95%置信区间 1.011.18）与 LDL-C 目标达标几率更高显著相关。相比之下，ApoA1 水平较高（OR：0.73，95%置信区间 [0.67，0.79]）、患有代谢综合征（OR：0.64，95%置信区间 [0.53，0.76]）、CVD 风险较高（OR：0.33，95%置信区间 0.270.41）、忘记服药（OR：0.74，95%置信区间 0.620.88）和胆固醇正常后停药（OR：0.67，95%置信区间 0.55~0.82）的患者 LDL-C 目标达标几率较低。
该研究结果表明，高 CVD 风险和极高 CVD 风险的 T2DM 患者血脂异常的管理并不理想。
