[Prevalence of inapropriate LDL cholesterol levels in patients with coronary disease and/or type 2 diabetes]

BACKGROUND AND OBJECTIVE

Clinical practice guidelines recommend achieving concentrations of LDL cholesterol less than 100 mg/dl (and in some cases less than 70 mg/dl) in patients with coronary artery disease and/or diabetes mellitus type 2 (DM2). We have examined the compliance with these objectives in patients treated in Spain with these conditions.

METHODS

Cross-sectional epidemiological study. Data were obtained during the visit of the study or, in their absence, based on data contained in the medical record by 874 doctors of the 17 autonomous communities in Spain. Demographic information, risk factors, cardiovascular and prescribed treatments were collected.

RESULTS

In the final analysis 6.988 (62.7% male) patients were included. 2586 (37%) had coronary disease, 2654 (38%) DM2 and 1748 (25%) both conditions. 65% had metabolic syndrome. Vascular risk factors median number was 4. 57% and 86% showed a concentration of LDL cholesterol >100 and >70 mg/dl respectively. The proportion patients with LDL concentration >100 mg/dl was 4% greater in the DM2 (62.4%) than in coronary patients (57.1%; p0.0001). Concentration of triglycerides >150 mg/dl was higher in patients with DM2 (50.5%) than in coronary patients (43.5%; p0.0001). The proportion of patients with LDL>70 mg/dl was similar in the coronary group and in the DM2 Group (88.4% and 87.0%, respectively). More than half of patients with coronary heart disease (57.5%) or DM2 (55.7%) showed inadequate levels of HDL (<40 mg/dl men; <50 mg/dl women).

CONCLUSIONS

More than a half of patients with diabetes mellitus and/or coronary artery disease enrolled in the CODIMET study do not achieve the recommended LDL cholesterol target for high cardiovascular risk patients.

[Prevalence and characteristics of lipid abnormalities in patients treated with statins in primary and secondary prevention in Spain. DYSIS-Spain Study]

INTRODUCTION AND OBJECTIVES

Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study.

METHODS

DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n=22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile.

RESULTS

Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n=2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n = 668) of those treated with statins were normal for all parameters.

CONCLUSIONS

Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement.

Sex does not influence prognosis in diabetic patients. The Barbanza Diabetes study

INTRODUCTION AND OBJECTIVES

To determine the influence of sex on cardiovascular complications in diabetic patients.

METHODS

This multicenter prospective cohort study involved 1423 consecutive patients with diabetes mellitus who were recruited during consultations with 31 primary care physicians. The patients' characteristics were recorded and they were followed up for 45 + or - 10 months.

RESULTS

The mean age of the patients (50% female) was 66 years, 64% had hypertension, 70% had dyslipidemia, and 26% had had a previous cardiovascular event. Cardiovascular disease, predominantly ischemic heart disease, was observed more frequently in men and a higher percentage had end-organ damage (57.7% of males versus 45.4% of females; P< .0001). Women had poorer glycemic control, higher total cholesterol levels and lower high-density lipoprotein cholesterol levels. By the end of follow-up, 81 patients had died (5.7% of males versus 6.7% of females; P=.513). There were no sex differences in cardiovascular complications during follow up (15.8% in males versus 13.7% in females; P=.368). Multivariate analysis identified the following factors as independent predictors of morbidity or mortality: age (hazard ratio [HR]=1.04; 95% confidence interval [CI], 1.02-1.06), existing cardiovascular disease (HR=1.96; 95% CI, 1.38-2.79), diuretic treatment (HR=1.62; 95% CI, 1.10-2.38), and albuminuria (HR=1.86; 95% CI, 1.33-2.61).

CONCLUSIONS

No difference was observed in mediumterm prognosis, with regard to mortality and cardiovascular selecmorbidity, between male and female diabetics from the same geographical area, despite the presence of clinical differences between the sexes.