Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, INSERM UMR 1027, 31059 Toulouse, France.
Merck & Co., Inc., 07033 Kenilworth, NJ, United States of America.
Arch Cardiovasc Dis. 2020 Oct;113(10):617-629. doi: 10.1016/j.acvd.2020.05.013. Epub 2020 Aug 29.
Patients with type 2 diabetes mellitus characteristically display an atherogenic lipid profile with high triglyceride concentrations, low high-density lipoprotein cholesterol (HDL-C) concentrations and low-density lipoprotein cholesterol (LDL-C) concentrations not always elevated. It is unclear if patients with diabetes who present with an acute coronary syndrome (ACS) receive different or more-potent lipid-lowering therapy (LLT).
To investigate lipid abnormalities in patients with and without type 2 diabetes hospitalised for an ACS, and use of LLT before admission and 4 months after the event.
Patients were included in the observational DYSIS II study if they were hospitalised for an ACS and had a full lipid profile.
Of 3803 patients, diabetes was documented in 1344 (54.7%). Compared to patients without diabetes, those with diabetes had a lower mean LDL-C (101.2 vs. 112.0mg/dL; 2.6 vs. 2.9mmol/L; P<0.0001), with a greater proportion attaining concentrations<70mg/dL (1.8mmol/L) (23.9% vs. 16.0%; P<0.0001) and<55mg/dL (1.4mmol/L) (11.3% vs. 7.3%; P<0.0001), a higher mean triglyceride concentration (139.0 vs. 121.0mg/dL; 1.6 vs. 1.4mmol/L; P<0.0001) and a lower HDL-C concentration. LLT was more commonly given to patients with diabetes (77.5% vs. 58.8%; P<0.0001); there were no differences in types of therapy prescribed. Four months after hospitalisation, most patients from both groups were being treated with LLT (predominantly statin monotherapy).
Despite the different lipid profiles, the type of LLT prescribed did not vary depending on the presence or absence of type 2 diabetes. There was no difference in LLT in patients with and without diabetes at 4-month follow-up, except for fibrates, which were used in 2% of patients with and 1% of patients without diabetes. Statin monotherapy of intermediate potency was the predominant treatment in both groups.
2 型糖尿病患者的血脂谱通常具有致动脉粥样硬化特征，表现为甘油三酯浓度升高、高密度脂蛋白胆固醇（HDL-C）浓度降低、低密度脂蛋白胆固醇（LDL-C）浓度不总是升高。目前尚不清楚患有急性冠状动脉综合征（ACS）的糖尿病患者是否接受了不同或更强效的降脂治疗（LLT）。
调查因 ACS 住院的 2 型糖尿病患者和非 2 型糖尿病患者的血脂异常情况，并调查入院前和事件发生后 4 个月的 LLT 使用情况。
如果患者因 ACS 住院且血脂谱完整，将其纳入观察性 DYSIS II 研究。
在 3803 例患者中，有 1344 例（54.7%）有糖尿病病史。与无糖尿病的患者相比，有糖尿病的患者 LDL-C 平均值较低（101.2 与 112.0mg/dL；2.6 与 2.9mmol/L；P<0.0001），达到<70mg/dL（1.8mmol/L）（23.9%比 16.0%；P<0.0001）和<55mg/dL（1.4mmol/L）（11.3%比 7.3%；P<0.0001）的比例更大，甘油三酯浓度平均值较高（139.0 与 121.0mg/dL；1.6 与 1.4mmol/L；P<0.0001），HDL-C 浓度较低。给予糖尿病患者的 LLT 更常见（77.5%比 58.8%；P<0.0001）；所开的治疗类型没有差异。住院 4 个月后，大多数患者均接受 LLT（主要为他汀类药物单药治疗）。
尽管血脂谱不同，但无论是否存在 2 型糖尿病，所开的 LLT 类型并无差异。除了在 2%的糖尿病患者和 1%的非糖尿病患者中使用的贝特类药物外，糖尿病和非糖尿病患者在 4 个月随访时的 LLT 无差异。他汀类药物单药治疗（中效）是两组患者的主要治疗方法。
