Background: 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). Aims: 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. Methods: Patients were included in the observational DYSIS II study if they were hospitalised for an ACS and had a full lipid profile. Results: 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. 112.0 mg/dL; 2.6 vs. 2.9 mmol/L; P < 0.0001), with a greater proportion attaining concentrations < 70 mg/dL (1.8 mmol/L) (23.9% vs. 16.0%; P < 0.0001) and < 55 mg/dL (1.4 mmol/L) (11.3% vs. 7.3%; P < 0.0001), a higher mean triglyceride concentration (139.0 vs. 121.0 mg/dL; 1.6 vs. 1.4 mmol/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). Conclusions: 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.
Lipid-lowering treatment and low-density lipoprotein cholesterol target achievement in patients with type 2 diabetes and acute coronary syndrome
De Ferrari G. M.;
2020-01-01
Abstract
Background: 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). Aims: 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. Methods: Patients were included in the observational DYSIS II study if they were hospitalised for an ACS and had a full lipid profile. Results: 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. 112.0 mg/dL; 2.6 vs. 2.9 mmol/L; P < 0.0001), with a greater proportion attaining concentrations < 70 mg/dL (1.8 mmol/L) (23.9% vs. 16.0%; P < 0.0001) and < 55 mg/dL (1.4 mmol/L) (11.3% vs. 7.3%; P < 0.0001), a higher mean triglyceride concentration (139.0 vs. 121.0 mg/dL; 1.6 vs. 1.4 mmol/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). Conclusions: 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.
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