Amadid Hanan, Rønn Pernille F, Bekker-Nielsen Dunbar Maria, Knudsen Jakob S, Carstensen Bendix, Persson Frederik, Jørgensen Marit E
Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Diabetes Obes Metab. 2021 Oct;23(10):2354-2363. doi: 10.1111/dom.14478. Epub 2021 Jul 28.
To assess lipid-lowering drug (LLD) use patterns during 1996-2017 and examine lipid levels in relation to the use of LLDs and prevalent atherosclerotic cardiovascular disease (ASCVD).
Using a nationwide diabetes register, 404 389 individuals with type 2 diabetes living in Denmark during 1996-2017 were identified. Individuals were followed from 1 January 1996 or date of type 2 diabetes diagnosis until date of emigration, death or 1 January 2017. Redemptions of prescribed LLDs were ascertained from the nationwide Register of Medicinal Products Statistics. Data on lipid levels were sourced from the National Laboratory Database since 2010. LLD coverage was calculated at any given time based on the redeemed amount and dose. Trends in lipid levels were estimated using an additive mixed-effect model. Low-density lipoprotein cholesterol (LDL-C) goal attainment was assessed based on recommended targets by the 2011, 2016 and 2019 guidelines for management of dyslipidaemias.
LLD use has decreased since 2012 and only 55% of those with type 2 diabetes were LLD users in 2017. A decline in levels of total cholesterol and LDL-C, and an increase in triglycerides, was observed during 2010-2017. Annual mean levels of LDL-C were lower among LLD users compared with non-users (in 2017: 1.84 vs. 2.57 mmol/L). A greater fraction of LLD users achieved the LDL-C goal of less than 1.8 mmol/L compared with non-users (in 2017: 51.7% and 19%, respectively). Among LLD users with prevalent ASCVD, 26.9% and 55% had, as recommended by current 2019 European guidelines, an LDL-C level of less than 1.4 mmol/L and less than 1.8 mmol/L, respectively, in 2017.
LLD use and LDL-C levels are far from optimal in the Danish type 2 diabetes population and improvement in LLD use could reduce ASCVD events.
评估1996 - 2017年期间降脂药物（LLD）的使用模式，并研究血脂水平与LLD使用及动脉粥样硬化性心血管疾病（ASCVD）患病率之间的关系。
利用全国糖尿病登记系统，确定了1996 - 2017年期间居住在丹麦的404389例2型糖尿病患者。从1996年1月1日或2型糖尿病诊断日期开始对个体进行随访，直至移民、死亡日期或2017年1月1日。从全国药品统计登记系统中确定处方LLD的配药情况。自2010年起，血脂水平数据来源于国家实验室数据库。根据配药量和剂量计算任何给定时间的LLD覆盖率。使用加性混合效应模型估计血脂水平的趋势。根据2011年、2016年和2019年血脂异常管理指南推荐的目标评估低密度脂蛋白胆固醇（LDL-C）达标情况。
自2012年以来LLD使用量下降，2017年只有55%的2型糖尿病患者使用LLD。2010 - 2017年期间观察到总胆固醇和LDL-C水平下降，甘油三酯水平升高。与未使用者相比，LLD使用者的LDL-C年均水平较低（2017年：1.84 vs. 2.57 mmol/L）。与未使用者相比，LLD使用者中达到LDL-C目标值低于1.8 mmol/L的比例更高（2017年：分别为51.7%和19%）。在患有ASCVD的LLD使用者中，根据2019年欧洲现行指南的建议，2017年分别有26.9%和55%的患者LDL-C水平低于1.4 mmol/L和低于1.8 mmol/L。
在丹麦2型糖尿病患者中，LLD的使用和LDL-C水平远未达到最佳状态，改善LLD的使用可减少ASCVD事件。
