Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey.
Eur J Clin Invest. 2021 Jul;51(7):e13528. doi: 10.1111/eci.13528. Epub 2021 Mar 11.
Effective treatment of high low-density lipoprotein cholesterol (LDL-C) levels has been shown to improve cardiovascular outcomes of patients with diabetes mellitus (DM). Herein, we aimed to provide insight to the real-life management of patients with DM in terms of LDL-C goal attainment and adherence to lipid management recommendations. Our objective was also to reveal the reasons of poor LDL-C goal attainment by assessing the perceptions of both physicians and patients.
We compared the diabetic and non-diabetic patients from the database of a nationwide registry conducted in cardiology outpatient clinics with regard to the demographic characteristics, educational status, comorbidities, medications, laboratory parameters and LDL-C goal attainment. Also, both the patients and attending physicians were surveyed to analyse perceptions and awareness of hypercholesterolemia.
Of the 1868 consecutively enrolled patients, 873 (47%) had DM. Proportion of patients on statins was significantly lower in patients with DM (67.8% vs 55.3%; P < .001). The proportion of patients who attained LDL-C targets were lower among the diabetic patients (17.8% vs 15%; P = .06). The most common causes of the discontinuation of statin therapy were negative media coverage about statins (32.1%), and recommendations of physicians to stop the lipid lowering therapy (29.6%). Analysis of the physician survey revealed that the physicians could determine the off-target patients accurately (negative predictive value 98.4%) while the positive predictive value (48.8%) was low. The reasons for not attaining the LDL-C goals in diabetic patients were not prescription of statins (38%) and inadequate (eg low-dose, non-adherent) statin (28.3%) dosages.
In real-life clinical cardiology practice, diabetic patients are far below the recommended LDL-C treatment goals. High-intensity statin treatment in diabetic population is still avoided because of the concerns about polypharmacy and drug interactions. Also, the inertia of physicians and even cardiologists is probably a major cause of refraining of prescription of optimal statin dosages.
有效降低高低密度脂蛋白胆固醇（LDL-C）水平已被证明可改善糖尿病（DM）患者的心血管结局。在此，我们旨在根据 LDL-C 达标情况和对脂质管理建议的依从性，深入了解 DM 患者的实际治疗情况。我们的目的还在于通过评估医生和患者的看法，揭示 LDL-C 不达标的原因。
我们比较了来自全国心血管门诊登记数据库的糖尿病和非糖尿病患者的人口统计学特征、教育程度、合并症、药物、实验室参数和 LDL-C 达标情况。此外，还对患者和主治医生进行了调查，以分析对高胆固醇血症的认识和意识。
在连续纳入的 1868 例患者中，873 例（47%）患有 DM。在 DM 患者中，使用他汀类药物的比例明显较低（67.8%比 55.3%；P<0.001）。在糖尿病患者中，达到 LDL-C 目标的患者比例较低（17.8%比 15%；P=0.06）。停止他汀类药物治疗的最常见原因是他汀类药物的负面媒体报道（32.1%）和医生建议停止降脂治疗（29.6%）。对医生调查的分析表明，医生可以准确地确定目标不达标的患者（阴性预测值 98.4%），而阳性预测值（48.8%）较低。DM 患者未达到 LDL-C 目标的原因是未开具他汀类药物（38%）和他汀类药物剂量不足（如低剂量、不依从）（28.3%）。
在现实临床心脏病学实践中，糖尿病患者远低于推荐的 LDL-C 治疗目标。由于担心药物相互作用和药物过多，糖尿病患者仍避免使用高强度他汀类药物治疗。此外，医生甚至心脏病专家的惯性可能是避免开具最佳他汀类药物剂量的主要原因。
