Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye.
Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye.
Anatol J Cardiol. 2023 Feb;27(2):78-87. doi: 10.14744/AnatolJCardiol.2022.2012.
The recent 2019 European Society of Cardiology/European Atherosclerosis Society practice guidelines introduced a new risk categorization for patients with diabetes. We aimed to compare the implications of the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines with regard to the lipid-lowering treatment use, low-density lipoprotein cholesterol goal attainment rates, and the estimated proportion of patients who would be at goal in an ideal setting.
Patients with diabetes were classified into 4 risk categories according to 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidemia guidelines from the database of EPHESUS (cross-sectional, observational, countrywide registry of cardiology outpatient clinics) study. The use of lipid-lowering treatment and low-density lipoprotein cholesterol goal attainment rates were then compared according to previous and new guidelines.
This analysis included a total of 873 diabetic adults. Half of the study population (53.8%) were on lipid-lowering treatment and almost one-fifth (19.1%) were on high-intensity statins. While low-density lipoprotein cholesterol goal was achieved in 19.5% and 7.5% of patients, 87.4% and 69.6% would be on target if their lipid-lowering treatment was intensified according to 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society lipid guidelines, respectively. The new target <55 mg/dL could only be achieved in 2.2% and 8.1% of very high-risk primary prevention and secondary prevention patients, respectively.
The control of dyslipidemia was extremely poor among patients with diabetes. The use of lipid-lowering treatment was not at the desired level, and high-intensity lipid-lowering treatment use was even lower. Our simulation model showed that the high-dose statin plus ezetimibe therapy would improve goal attainment; however, it would not be possible to get goals with this treatment in more than one-third of the patients.
最近的 2019 年欧洲心脏病学会/欧洲动脉粥样硬化学会实践指南为糖尿病患者引入了新的风险分类。我们旨在比较 2016 年和 2019 年欧洲心脏病学会/欧洲动脉粥样硬化学会指南在降脂治疗使用、低密度脂蛋白胆固醇目标达标率以及在理想情况下达到目标的患者比例方面的差异。
根据 EPHESUS（横断面、观察性、全国心血管门诊注册研究）研究数据库中 2019 年欧洲心脏病学会/欧洲动脉粥样硬化学会血脂异常指南，将糖尿病患者分为 4 个风险类别。然后，根据以前和新指南比较降脂治疗的使用和低密度脂蛋白胆固醇目标达标率。
这项分析共纳入 873 名成年糖尿病患者。研究人群的一半（53.8%）正在接受降脂治疗，近五分之一（19.1%）正在服用高强度他汀类药物。尽管有 19.5%和 7.5%的患者达到了低密度脂蛋白胆固醇目标，但如果根据 2016 年和 2019 年欧洲心脏病学会/欧洲动脉粥样硬化学会血脂指南强化降脂治疗，87.4%和 69.6%的患者将会达标。新的目标<55mg/dL 仅能在非常高危的一级预防和二级预防患者中分别达到 2.2%和 8.1%。
糖尿病患者的血脂异常控制极差。降脂治疗的使用未达到预期水平，高强度降脂治疗的使用更低。我们的模拟模型显示，大剂量他汀类药物加依折麦布联合治疗可以提高达标率；然而，这种治疗方法不可能使三分之一以上的患者达到目标。
