medwireNews: Guideline-recommended lipid targets are being “rarely achieved” in adults with type 1 and type 2 diabetes who are at high or very high risk for cardiovascular (CV) disease, say researchers who have performed a large real-world registry-based study.
Only 6.2% of 4725 people with type 1 diabetes at very high CV risk had a recommended low-density lipoprotein cholesterol (LDL-C) level of less than 55 mg/dL (1.4 mmol/L), as set out by the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines on the management of dyslipidemias. And just 11.0% of 2590 with type 1 diabetes at high CV risk had the recommended LDL-C level of less than 70 mg/dL (1.8 mmol/L).
Equally low numbers of people with type 2 diabetes at very high (n=19,174) and high (n=4265) CV risk had lipid levels within these goals, at a respective 11.8% and 16.3%.
While the attainment of non-high density lipoprotein cholesterol (non-HDL-C) targets was better, levels were still often below the recommendations of less than 85 mg/dL (2.2 mmol/L) for individuals at very high CV risk and less than 100 g/dL (2.6 mmol/L) for those at high CV risk in people with type 1 diabetes (15.3% and 25.5%, respectively) or type 2 diabetes (18.6% and 18.0%).
These data “indicate a gap between guideline recommendations for lipid lowering and translation into real-world practice,” say Julia Brandts (University Hospital Aachen, Germany) and collaborators in Diabetes Obesity and Metabolism.
Their analysis was based on data collected between 2020 and 2022 for 32,170 adults within the German Diabetes Care Evaluation (DIVE) and the Austrian Diabetes Patient Follow-up Documentation (DPV) databases.
The participants were grouped according to their CV risk as specified in the ESC/EAS guidelines, which defines very high risk as those with established CV disease and diabetes with target organ damage or at least three major CV risk factors, such as hypertension and dyslipidemia, or early-onset type 1 diabetes of more than 20 years duration. High risk includes people with diabetes of at least 10 years duration or another additional risk factor and without target organ damage.
Lipid-lowering therapy alongside lifestyle modifications is one of the cornerstones of CV risk management, say the researchers but they found that fewer than one in five people with type 1 diabetes were being treated with statins (19.3%). Even fewer were treated with ezetimibe (2.2%), and barely any received treatment with proprotein convertase subtilisin/kexin type 9 (PCKS9) inhibitors (0.1%) or fibrates (0.2%).
Although more people with type 2 diabetes received statin therapy, at 45.7%, the use of the other lipid-lowering agents was still very low, at 3.4% for ezetimibe, 0.1% for PCKS9 inhibitors, and 1.0% for fibrates.
Examining prescription rates by CV risk category, the researchers found that 31.4% of individuals with type 1 diabetes at very high risk were being treated with lipid-lowering therapy, mostly with statins, but that only 6.0% at high risk were being treated. Corresponding figures for individuals with type 2 diabetes at very high and high risk were 52.4% and 29.5%.
“Combination [lipid-lowering therapy] was rarely used,” observe the researchers.
They suggest: “The barriers to using combination therapy and escalating treatment strategies according to CV risk need to be examined and addressed in clinical practice.”
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