García Díaz Eduardo, Ramírez Medina Davinia, Morera Porras Óscar Mauricio, Cabrera Mateos José Luis
Unidad de Endocrinología, Hospital Dr. José Molina Orosa, Lanzarote, España.
Unidad de Nefrología, Hospital Dr. José Molina Orosa, Lanzarote, España.
Endocrinol Diabetes Nutr (Engl Ed). 2019 Apr;66(4):223-231. doi: 10.1016/j.endinu.2018.08.014. Epub 2018 Dec 9.
To assess the control of cLDL in diabetic patients, to measure the impact on such control of inertia with lipid-lowering agents and to explore factors that allow for predicting this inertia.
Study of historical cohorts of diabetic patients. The proportion of patients who achieved the target cLDL levels was estimated. Therapeutic inertia was considered when the dose of the lipid-lowering agents was not adjusted, or a lipid-lowering agent was not changed or added in patients with initial cLDL outside the target. Change in cLDL from the first to the last visit and inertia with lipid-lowering drugs were analyzed according to comorbidities, cardiovascular risk factors and treatments used.
The study simple consisted of 639 patients (mean follow-up time 11.1±11.2 months), of whom 27.5% achieved target cLDL levels. Inertia occurred in 43,6% of patients with initial cLDL outside the target. Independent predictors of inertia were the initial cLDL (P<0.001), polyneuropathy (P=0.014), adjustment of antihypertensive agents (P=0.002), adequacy of lipid-lowering agents (P<0.001), use of ezetimibe (P=0.001) and adherence to lipid-lowering drugs (P=0.015).
Inertia with lipid-lowering agents in a diabetic patient is less frequent in the presence of higher cLDL values, in cases of polyneuropathy, when antihypertensive agents are adjusted or changed, and when non-adherence is detected. The adequate initial prescription of statins and the association with ezetimibe decrease the likelihood of committing inertia.
评估糖尿病患者中cLDL的控制情况，衡量降脂药物治疗惰性对这种控制的影响，并探索能够预测这种惰性的因素。
对糖尿病患者的历史队列进行研究。估算达到cLDL目标水平的患者比例。当初始cLDL未达目标的患者未调整降脂药物剂量、未更换或添加降脂药物时，视为存在治疗惰性。根据合并症、心血管危险因素及所用治疗方法，分析首次就诊至末次就诊时cLDL的变化以及降脂药物治疗惰性情况。
该研究共纳入639例患者（平均随访时间11.1±11.2个月），其中27.5%达到cLDL目标水平。初始cLDL未达目标的患者中，43.6%存在治疗惰性。治疗惰性的独立预测因素包括初始cLDL（P<0.001）、多发性神经病变（P=0.014）、抗高血压药物调整（P=0.002）、降脂药物的充分性（P<0.001）、依折麦布的使用（P=0.001）以及降脂药物依从性（P=0.015）。
在糖尿病患者中，当cLDL值较高、存在多发性神经病变、抗高血压药物进行调整或更换以及检测到不依从时，降脂药物治疗惰性的发生频率较低。他汀类药物的初始合理处方以及与依折麦布联合使用可降低发生治疗惰性的可能性。
