Masson Walter, Huerín Melina, Lobo Lorenzo Martin, Masson Gerardo, Molinero Graciela, Nemec Mariano, Boccadoro Mariela, Romero Cinthia, Micali Gabriel, Siniawski Daniel
Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Buenos Aires C1115AAD, Argentina.
Argentine Society of Lipids, Córdoba X5000JGQ, Argentina.
J Cardiovasc Dev Dis. 2020 Feb 5;7(1):6. doi: 10.3390/jcdd7010006.
Recent European guidelines on diabetes, prediabetes, and cardiovascular disease developed for the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) significantly changed some concepts on risk stratification, lipid goals, and recommendations for the use of lipid-lowering drugs. The objectives of this work were to describe the lipid-lowering treatment prescribed for patients with diabetes and to determine the percentage of patients that achieved the lipid goals recommended by the 2019 ESC/EASD Guidelines on Diabetes in real and simulated scenarios.
A multicenter, cross-sectional study was performed. Subjects >18 years with type 2 diabetes were included. The recommendations of the 2019 ESC/EASD Guidelines were followed. The real and simulated (ideal setting using adequate doses of statins ± ezetimibe) scenarios were analyzed.
Overall, 528 patients were included. In total, 62.5% of patients received statins (17.1% high intensity). Most patients were stratified as "very high risk" (54.2%) or "high risk" (43.4%). Only 13.3% achieved the double lipid goal (LDL-C and non-HDL-C goals according to the risk categories). In the simulation analysis, the proportion of subjects that did not reach the therapeutic objective decreased in all risk strata, although a considerable proportion of subjects persisted outside the target.
The difficulty of achieving lipid goals in diabetic patients was considerable when applying the new guidelines. The situation would improve if we optimized treatment, but the prescription of new lipid-lowering drugs could be limited by their high cost.
近期欧洲心脏病学会（ESC）与欧洲糖尿病研究协会（EASD）合作制定的关于糖尿病、糖尿病前期和心血管疾病的欧洲指南，显著改变了一些关于风险分层、血脂目标以及使用降脂药物建议的概念。这项工作的目的是描述糖尿病患者的降脂治疗情况，并确定在实际和模拟场景中达到2019年ESC/EASD糖尿病指南推荐的血脂目标的患者百分比。
进行了一项多中心横断面研究。纳入年龄大于18岁的2型糖尿病患者。遵循2019年ESC/EASD指南的建议。分析了实际和模拟（使用适当剂量他汀类药物±依泽替米贝的理想情况）场景。
总共纳入了528例患者。总体而言，62.5%的患者接受了他汀类药物治疗（17.1%为高强度治疗）。大多数患者被分层为“极高风险”（54.2%）或“高风险”（43.4%）。只有13.3%的患者达到了双重血脂目标（根据风险类别确定的低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇目标）。在模拟分析中，所有风险分层中未达到治疗目标的受试者比例均有所下降，尽管仍有相当比例的受试者未达到目标。
应用新指南时，糖尿病患者实现血脂目标存在相当大的困难。如果我们优化治疗，情况将会改善，但新的降脂药物的处方可能会受到其高成本的限制。
