Nguyen Huan Thanh, Ha Khang Pham Trong, Nguyen An Huu, Nguyen Thu Thanh, Lam Hang My
Department of Geriatrics and Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam.
Department of Cardiology, Thong Nhat Hospital, Ho Chi Minh, Vietnam.
Ann Geriatr Med Res. 2021 Dec;25(4):278-285. doi: 10.4235/agmr.21.0099. Epub 2021 Dec 6.
Lowering the low-density lipoprotein cholesterol (LDL-c) level is important for reducing cardiovascular (CV) events. However, little is known about the management of LDL-c in older patients with type 2 diabetes mellitus (T2DM). This study investigated the prevalence and factors associated with the non-achievement of LDL-c goals in older T2DM patients with a very high risk of CV diseases.
This multicenter cross-sectional study measured the LDL-c levels of 733 T2DM outpatients from December 2019 to July 2020. The patients were aged ≥60 years, had very high risks of CV disease, and had been on LDL-c-lowering therapy for 6 months or more. The goal of lipid concentrations were assessed based on the recent guidelines of the European Society of Cardiology. We applied logistic regression analysis to identify the factors associated with the non-achievement of the LDL-c goal.
The mean age of the patients was 68.6±7.2 years. In total, 654 patients (89.2%) did not achieve the aggressive LDL-c goal of <1.4 mmol/L. In the adjusted model, the factors associated with the non-achievement of the LDL-c goal were obesity defined by body mass index (odds ratio [OR]=2.33; 95% confidence interval [CI], 1.13-4.81; p=0.022) and high-intensity statin therapy (OR=0.03; 95% CI, 0.01-0.05; p<0.001), while age, sex, education level, smoking habit, and comorbidities were not associated.
Older patients with T2DM who are at a very high CV disease risk are often unable to achieve their LDL-c goal. Obesity can increase the probability of not achieving the LDL-c goal, whereas high-intensity statin therapy can decrease this probability.
降低低密度脂蛋白胆固醇（LDL-c）水平对于减少心血管（CV）事件至关重要。然而，对于老年2型糖尿病（T2DM）患者中LDL-c的管理知之甚少。本研究调查了心血管疾病风险极高的老年T2DM患者中未达到LDL-c目标的患病率及相关因素。
这项多中心横断面研究在2019年12月至2020年7月期间测量了733例T2DM门诊患者的LDL-c水平。患者年龄≥60岁，心血管疾病风险极高，且已接受LDL-c降低治疗6个月或更长时间。根据欧洲心脏病学会的最新指南评估血脂浓度目标。我们应用逻辑回归分析来确定与未达到LDL-c目标相关的因素。
患者的平均年龄为68.6±7.2岁。总共有654例患者（89.2%）未达到<1.4 mmol/L的积极LDL-c目标。在调整模型中，与未达到LDL-c目标相关的因素是由体重指数定义的肥胖（比值比[OR]=2.33；95%置信区间[CI]，1.13 - 4.81；p=0.022）和高强度他汀类药物治疗（OR=0.03；95% CI，0.01 - 0.05；p<0.001），而年龄、性别、教育水平、吸烟习惯和合并症则无关。
心血管疾病风险极高的老年T2DM患者往往无法达到其LDL-c目标。肥胖会增加未达到LDL-c目标的概率，而高强度他汀类药物治疗可降低此概率。
