Department of Medical Sciences, University of Torino and Division of Cardiology Azienda Ospedaliera Universitaria Città della Salute di Torino, Turin, Italy.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
Am Heart J. 2020 Feb;220:82-88. doi: 10.1016/j.ahj.2019.11.005. Epub 2019 Nov 13.
Type 2 diabetes (T2D) patients are at increased risk for cardiovascular (CV) events. Most guidelines recommend treating low-density lipoprotein cholesterol (LDL-C) levels to ≤70 mg/dL (1.8 mM) for patients with T2D and established atherosclerotic CV disease, and some a more aggressive target of ≤55 mg/dL (1.4 mM). Our objective was to assess the degree to which these LDL-C targets are achieved in routine practice.
Using data from TECOS, an international pragmatic CV outcomes trial of sitagliptin vs placebo, we assessed lipid-lowering treatment among patients with T2D and CV disease, baseline lipid values, and the association between baseline LDL-C and 5-year risk for major adverse cardiac events (MACE; ie, CV death, nonfatal myocardial infarction, or nonfatal stroke).
Overall, 11,066 of 14,671 TECOS participants (75.4%) had LDL-C measured at baseline. Median age was 65 years, 72% were male, and median T2D duration was 10 years. Overall, 82.5% of patients were on statins; only 5.8% were on ezetimibe. At baseline, 14.3% had LDL-C ≤55 mg/dL, 18.4% between 55.1 and 70 mg/dL, 35% between 70.1 and 100 mg/dL, and 32.3% >100 mg/dL. Each 10 mg/dL higher LDL-C value was associated with a higher risk of MACE (HR 1.05, 95% CI 1.03-1.07) or CV death (HR 1.06, 95% CI 1.04-1.09).
Although most high-risk patients with T2D and CV disease were on lipid-lowering therapy, only 1:3 had LDL-C <70 mg/dL and 1:6 had LDL-C <55 mg/dL. Each 10 mg/dL higher LDL-C value was associated with a 5% and 6% higher 5-year incidence of MACE and CV death, respectively. (TECOS, NCT00790205).
2 型糖尿病（T2D）患者发生心血管（CV）事件的风险增加。大多数指南建议将 LDL-C 水平控制在 T2D 合并已确诊动脉粥样硬化性 CV 疾病患者的 ≤70mg/dL（1.8mmol/L），部分指南建议更积极的目标值为 ≤55mg/dL（1.4mmol/L）。我们的目的是评估在常规实践中这些 LDL-C 目标的实现程度。
利用来自 TECOS 的数据，这是一项关于西格列汀与安慰剂对照的国际性实用 CV 结局试验，我们评估了 T2D 合并 CV 疾病患者的降脂治疗、基线血脂值以及基线 LDL-C 与 5 年主要不良心脏事件（MACE；即 CV 死亡、非致死性心肌梗死或非致死性卒中）风险之间的关系。
总体而言，在 TECOS 的 14671 名参与者中，有 11066 名（75.4%）在基线时测量了 LDL-C。中位年龄为 65 岁，72%为男性，中位 T2D 病程为 10 年。总体而言，82.5%的患者服用他汀类药物；仅 5.8%的患者服用依折麦布。基线时，14.3%的患者 LDL-C≤55mg/dL，18.4%的患者 LDL-C 在 55.1-70mg/dL 之间，35%的患者 LDL-C 在 70.1-100mg/dL 之间，32.3%的患者 LDL-C＞100mg/dL。每 10mg/dL 更高的 LDL-C 值与更高的 MACE（HR 1.05，95%CI 1.03-1.07）或 CV 死亡（HR 1.06，95%CI 1.04-1.09）风险相关。
尽管大多数 T2D 合并 CV 疾病的高危患者接受了降脂治疗，但仅有 1/3 的患者 LDL-C＜70mg/dL，1/6 的患者 LDL-C＜55mg/dL。每 10mg/dL 更高的 LDL-C 值与 5 年内 MACE 和 CV 死亡的发生率分别增加 5%和 6%相关。（TECOS，NCT00790205）。
