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Villar-Taibo R, Fernández-Rodríguez E, Tejera-Pérez C, Díaz-Ortega C, Sánchez-Sobrino P, Palmeiro-Carballeira R, Rodríguez-Novo N, Rodríguez-Carnero G, Pinal-Osorio I, Cotovad-Bellas L, Díaz-Trastoy O, Mantiñán-Gil B, Álvarez-Castro P, Andújar Plata P, Seoane-Cruz I, Prieto-Tenreiro A, Argüeso Armesto R, Fernández-Pombo A, Sánchez-Bao A, Vidal-Casariego A. GALIPDIA study: Reaching lipid targets in a population with type 2 diabetes (T2DM) from the Northwest of Spain. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:29-38. [PMID: 36764745 DOI: 10.1016/j.endien.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 02/11/2023]
Abstract
AIM To assess the degree of compliance with the European ESC/EAS 2016 and 2019 dyslipidaemia guidelines in patients with type 2 diabetes mellitus (T2DM). METHODS Multicentre retrospective cross-sectional study, conducted in 380 adults with T2DM and dyslipidaemia in 7 Spanish health areas. INCLUSION CRITERIA minimum follow-up of one year in Endocrinology Units, at least one visit in 2020 and a lipid profile measurement in the last 3 months. EXCLUSION CRITERIA familial hypercholesterolaemia, recent hospitalisation, active oncological pathology and dialysis. RESULTS According to the 2016 and 2019 guidelines the majority of patients were classified as being at very high cardiovascular risk (86.8% vs. 72.1%, respectively). LDL-c compliance was adequate in 62.1% of patients according to the 2016 guidelines and 39.7% according to the 2019 guidelines (p<0.001). Clinical conditions such as history of cardiovascular disease and therapy-related aspects (use of statins, especially high-potency statins, combination therapies and good adherence) were significantly associated with greater achievement of lipid targets. CONCLUSION There is a discrepancy between dyslipidaemia guideline recommendations and the reality of lipid control in patients with T2DM, despite most of these patients being at very high cardiovascular risk. Strategies to optimise lipid-lowering treatments need to be implemented.
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Affiliation(s)
- Rocío Villar-Taibo
- Division of Endocrinology, University Clinical Hospital of Santiago de Compostela, C/ Choupana, s/n, 15706 Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Eva Fernández-Rodríguez
- Division of Endocrinology, University Clinical Hospital of Ourense, C/ Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Cristina Tejera-Pérez
- Division of Endocrinology, University Clinical Hospital of Ferrol, Avda. de la Residencia S/N, 15405 Ferrol, A Coruña, Spain; Epigenomics in Endocrinology and Nutrition Group, Instituto de Investigacion Sanitaria de Santiago (IDIS), C/ Choupana, s/n, 15706 Santiago de Compostela, Spain.
| | - Carmen Díaz-Ortega
- Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Division of Endocrinology, University Clinical Hospital of Ourense, C/ Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Paula Sánchez-Sobrino
- Division of Endocrinology, University Clinical Hospital of Montecelo, C/ Mourente, s/n, 36071 Pontevedra, Spain
| | - Regina Palmeiro-Carballeira
- Division of Endocrinology, University Clinical Hospital of Vigo, Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, Spain
| | - Nazareth Rodríguez-Novo
- Division of Endocrinology, University Clinical Hospital of Lugo, C/ Doctor Ulises Romero, 1, 27003 Lugo, Spain
| | - Gemma Rodríguez-Carnero
- Division of Endocrinology, University Clinical Hospital of Santiago de Compostela, C/ Choupana, s/n, 15706 Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Iria Pinal-Osorio
- Division of Endocrinology, University Clinical Hospital of Ourense, C/ Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Laura Cotovad-Bellas
- Division of Endocrinology, University Clinical Hospital of Ferrol, Avda. de la Residencia S/N, 15405 Ferrol, A Coruña, Spain
| | - Olaia Díaz-Trastoy
- Division of Endocrinology, University Clinical Hospital of Montecelo, C/ Mourente, s/n, 36071 Pontevedra, Spain
| | - Beatriz Mantiñán-Gil
- Division of Endocrinology, University Clinical Hospital of Vigo, Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, Spain
| | - Paula Álvarez-Castro
- Division of Endocrinology, University Clinical Hospital of Lugo, C/ Doctor Ulises Romero, 1, 27003 Lugo, Spain
| | - Paula Andújar Plata
- Division of Endocrinology, University Clinical Hospital of Santiago de Compostela, C/ Choupana, s/n, 15706 Santiago de Compostela, Spain
| | - Inés Seoane-Cruz
- Division of Endocrinology, University Clinical Hospital of Ourense, C/ Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Alma Prieto-Tenreiro
- Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Division of Endocrinology, University Clinical Hospital of Ferrol, Avda. de la Residencia S/N, 15405 Ferrol, A Coruña, Spain
| | - Rosa Argüeso Armesto
- Division of Endocrinology, University Clinical Hospital of Lugo, C/ Doctor Ulises Romero, 1, 27003 Lugo, Spain
| | - Antía Fernández-Pombo
- Division of Endocrinology, University Clinical Hospital of Santiago de Compostela, C/ Choupana, s/n, 15706 Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana Sánchez-Bao
- Division of Endocrinology, University Clinical Hospital of Ferrol, Avda. de la Residencia S/N, 15405 Ferrol, A Coruña, Spain
| | - Alfonso Vidal-Casariego
- Division of Endocrinology, University Clinical Hospital of A Coruña, C/ Xubias de Arriba, 84, 15006 A Coruña, Spain
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Association of country economy and socioeconomic factors on risk factor control for primary prevention of cardiovascular disease in patients with diabetes mellitus: Insights from the DISCOVER Study. Indian Heart J 2022; 74:398-405. [PMID: 35926587 DOI: 10.1016/j.ihj.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We sought to describe global patterns in achievement of risk factor control for primary prevention in patients with T2D and explore the association of country's GNI/capita with risk factor control. METHODS The DISCOVER study is a prospective, observational study of patients with T2D from 38 countries enrolled at initiation of second-line glucose-lowering therapy. We examined achievement of risk factor control (glycosylated hemoglobin <7%, blood pressure <140/90 mmHg, prescription of a statin) at 3 years among those without optimal control at baseline. Countries were stratified by gross national income (GNI)/capita, from 2017). We examined the impact of country GNI/capita with achievement of risk factor control. FINDINGS Our cohort included 9613 patients with T2D and without baseline cardiovascular disease (mean age 57.2 ± 8.7 years, 47.9% women). At baseline, 6354/7646 patients (83.1%) had suboptimal glucose control, 3449/9200 patients (37.5%) had suboptimal BP control, and 2800/4221 patients (66.7%) were not on an appropriate statin (sample sizes differed due to missing covariate data). Optimal control at 3 years of follow-up was achieved in 41% (glucose), 56% (blood pressure), and 29% (statins) of patients. There was significant variability in achievement of risk factor control across countries but no association between country GNI/capita with achievement of risk factor control (p>0.08 for all). INTERPRETATION In a global, prospective study of patients with T2D, we found that cardiovascular risk factor control achievement was suboptimal despite 3 years of follow-up in specialized health care systems. Neither country-level nor patient-level socioeconomic factors fully explained this finding.
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Young RA. What do we mean, 'necessary'?-Achieving balance and recognizing limits in primary healthcare and universal healthcare. J Eval Clin Pract 2022; 28:341-344. [PMID: 33760312 DOI: 10.1111/jep.13545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
Sturmberg and Martin make a compelling case for primary healthcare (PHC) to be the foundation for universal healthcare (UHC). They state that a system should have necessary resources, but what does that mean? Basic economic theory postulates that all resources are limited and that choices must be made between competing options. For a UHC system to be successful and resilient, it must accept that healthcare is a limited right, there will always be inequalities in healthcare delivery and outcomes, primary care physicians and their teams must accept the added burden of balancing the needs of their personal patients with the greater system, leaders and observers of healthcare systems must accept that moderation and balance will often be the best outcome even though they are difficult to measure, and leaders of healthcare systems must accept that they cannot control the system, but contribute by providing context and limited constraints, information, and resources. A deeper understanding of complex adaptive systems will best guide these necessary changes.
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Affiliation(s)
- Richard A Young
- John Peter Smith Family Medicine Residency Program, Fort Worth, Texas, USA
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Amadid H, Rønn PF, Bekker-Nielsen Dunbar M, Knudsen JS, Carstensen B, Persson F, Jørgensen ME. A large remaining potential in lipid-lowering drug treatment in the type 2 diabetes population: A Danish nationwide cohort study. Diabetes Obes Metab 2021; 23:2354-2363. [PMID: 34189831 DOI: 10.1111/dom.14478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/16/2021] [Accepted: 06/27/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess lipid-lowering drug (LLD) use patterns during 1996-2017 and examine lipid levels in relation to the use of LLDs and prevalent atherosclerotic cardiovascular disease (ASCVD). METHODS Using a nationwide diabetes register, 404 389 individuals with type 2 diabetes living in Denmark during 1996-2017 were identified. Individuals were followed from 1 January 1996 or date of type 2 diabetes diagnosis until date of emigration, death or 1 January 2017. Redemptions of prescribed LLDs were ascertained from the nationwide Register of Medicinal Products Statistics. Data on lipid levels were sourced from the National Laboratory Database since 2010. LLD coverage was calculated at any given time based on the redeemed amount and dose. Trends in lipid levels were estimated using an additive mixed-effect model. Low-density lipoprotein cholesterol (LDL-C) goal attainment was assessed based on recommended targets by the 2011, 2016 and 2019 guidelines for management of dyslipidaemias. RESULTS LLD use has decreased since 2012 and only 55% of those with type 2 diabetes were LLD users in 2017. A decline in levels of total cholesterol and LDL-C, and an increase in triglycerides, was observed during 2010-2017. Annual mean levels of LDL-C were lower among LLD users compared with non-users (in 2017: 1.84 vs. 2.57 mmol/L). A greater fraction of LLD users achieved the LDL-C goal of less than 1.8 mmol/L compared with non-users (in 2017: 51.7% and 19%, respectively). Among LLD users with prevalent ASCVD, 26.9% and 55% had, as recommended by current 2019 European guidelines, an LDL-C level of less than 1.4 mmol/L and less than 1.8 mmol/L, respectively, in 2017. CONCLUSIONS LLD use and LDL-C levels are far from optimal in the Danish type 2 diabetes population and improvement in LLD use could reduce ASCVD events.
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Affiliation(s)
- Hanan Amadid
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Pernille F Rønn
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | | | - Jakob S Knudsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bendix Carstensen
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Frederik Persson
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Ling JZJ, Montvida O, Khunti K, Zhang AL, Xue CC, Paul SK. Therapeutic inertia in the management of dyslipidaemia and hypertension in incident type 2 diabetes and the resulting risk factor burden: Real-world evidence from primary care. Diabetes Obes Metab 2021; 23:1518-1531. [PMID: 33651456 DOI: 10.1111/dom.14364] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate trends in the prevalence of hypertension and dyslipidaemia in incident type 2 diabetes (T2DM), time to antihypertensive (AHT) and lipid-lowering therapy (LLT), and the association with systolic blood pressure (SBP) and lipid control. RESEARCH DESIGN AND METHODS Using The Health Improvement Network UK primary care database, 254 925 people with incident T2DM and existing dyslipidaemia or hypertension were identified. Among those without atherosclerotic cardiovascular disease (ASCVD) history and not on AHT or LLT at diagnosis, the adjusted median months to initiating an AHT or an LLT, and the probabilities of high SBP or lipid levels over 2 years in people initiating therapy within or after 1 year were evaluated according to high and low ASCVD risk status. RESULTS At diabetes diagnosis, 66% and 66% had dyslipidaemia and hypertension, respectively. During 2005 to 2016, dyslipidaemia prevalence increased by 10% in people aged <60 years, while hypertension prevalence remained stable in all age groups. Among those with high ASCVD risk status in the age groups 18 to 39, 40 to 49, and 50 to 59 years, the median number of months to initiation of therapy were 20.4 (95% confidence interval [CI] 20.3-20.5), 10.9 (95% CI 10.8-11.0), and 9.5 (95% CI 9.4-9.6) in the dyslipidaemia subcohort, and 28.1 (95% CI 28.0-28.2), 19.2 (95% CI 19.1-19.3), and 19.9 (95% CI 19.8-20.0) in the hypertension subcohort. Among people with high and low ASCVD risk status, respectively, compared to early LLT initiators, those who initiated LLT after 1 year had a 65.3% to 85.3% and a 65.0% to 85.3% significantly higher probability of failing lipid control at 2 years of follow-up, while late AHT initiators had a 46.5% to 57.9% and a 40.0% to 58.7% significantly higher probability of failing SBP control. CONCLUSIONS Significant delay in initiating cardioprotective therapies was observed, and time to first prescription was similar in the primary prevention setting, irrespective of ASCVD risk status across all T2DM diagnosis age groups, resulting in poor risk factor control at 2 years of follow-up.
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Affiliation(s)
- Joanna Z J Ling
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Olga Montvida
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Kamlesh Khunti
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Anthony L Zhang
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Charlie C Xue
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
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Zhao Y, Xiang P, Coll B, López JAG, Wong ND. Diabetes associated residual atherosclerotic cardiovascular risk in statin-treated patients with prior atherosclerotic cardiovascular disease. J Diabetes Complications 2021; 35:107767. [PMID: 33168394 PMCID: PMC7870509 DOI: 10.1016/j.jdiacomp.2020.107767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/17/2020] [Accepted: 10/18/2020] [Indexed: 01/07/2023]
Abstract
AIM In statin-treated persons with atherosclerotic cardiovascular disease (ASCVD) the further ASCVD risk that diabetes mellitus (DM) adds is not well-quantified. We examined this residual risk for initial and total recurrent ASCVD events. METHODS We studied 3271 patients with ASCVD on statin therapy in the AIM-HIGH clinical trial cohort. Cox regression and the Prentice, Williams, and Peterson model examined the excess risk of initial and total recurrent ASCVD events associated with DM over a 3- year mean follow-up. Predictors of first and total ASCVD events in those with and without DM were also examined. RESULTS Of our cohort with ASCVD on statin therapy 40% also had DM. Those with vs. without DM were older, were less likely to be male or white. They had higher systolic blood pressure, lower HDL-C, LDL-C, lipoprotein (a), but higher triglycerides and BMI (all p < 0.01). Adjusted HRs were 1.21 (95% CI; 1.01-1.46, p = 0.038) and 1.23 (95% CI: 1.05-1.44, p = 0.012) for first and total recurrent ASCVD events, respectively. Homocysteine and lipoprotein(a) most strongly predicted events in those with and without DM, respectively. CONCLUSION In statin-treated patients with ASCVD, DM was associated with significantly greater residual risk over ASCVD alone for both first and total recurrent ASCVD events.
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Affiliation(s)
- Yanglu Zhao
- University of California at Irvine, Heart Disease Prevention Program, Irvine, CA, USA; Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Nathan D Wong
- University of California at Irvine, Heart Disease Prevention Program, Irvine, CA, USA; Department of Epidemiology, University of California Los Angeles, Los Angeles, CA, USA.
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García-Ulloa AC, Lechuga-Fonseca C, Del Razo-Olvera FM, Aguilar-Salinas CA, Galaviz KI, Narayan KMV, Hernández-Jiménez S. Clinician prescription of lipid-lowering drugs and achievement of treatment goals in patients with newly diagnosed type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2021; 9:9/1/e001891. [PMID: 33568360 PMCID: PMC7878159 DOI: 10.1136/bmjdrc-2020-001891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Lipid control is essential in type 2 diabetes mellitus (T2DM). The aim of this study is to investigate factors associated with lipid therapy adherence and achievement of goals in real-life setting among patients with recently diagnosed T2DM. RESEARCH DESIGN AND METHODS This is a longitudinal analysis in a center of comprehensive care for patients with diabetes. We include patients with T2DM, <5 years of diagnosis, without disabling complications (eg, amputation, myocardial infarct, stroke, proliferative retinopathy, glomerular filtration rate <60 mL/min/m2) and completed 2-year follow-up. The comprehensive diabetes care model includes 9 interventions in 4 initial visits and annual evaluations. Endocrinologists follow the clinic's guideline and adapt therapy to reach risk-based treatment goal. The main outcome measures were the proportion of patients meeting low-density lipoprotein cholesterol (c-LDL) (<100 mg/dL) and triglycerides (<150 mg/dL) and proportion of patients taking statin, fibrate or combination at baseline, 3 months and annual evaluations. RESULTS We included 288 consecutive patients (54±9 years, 53.8% women), time since T2DM diagnosis 1 (0-5) year. Baseline, 10.8% patients were receiving statin therapy (46.5% moderate-intensity therapy and 4.6% high-intensity therapy), 8.3% fibrates and 4.2% combined treatment. The proportion of patients with combined treatment increased to 41.6% at 3 months, decreased to 20.8% at 1 year and increased to 38.9% at 2 years of evaluation. Patients receiving treatment met LDL and triglycerides goals at 3 months (17% vs 59.7%, relative ratio (RR)=0.89, 95% CI 0.71 to 1.12), at 1 year (17% vs 26.7%, RR=0.62, 95% CI 0.41 to 0.95) and at 2 years (17% vs 29.9%, RR=0.63, 95% CI 0.43 to 0.93). Main reasons for medication suspension: patient considered treatment was not important (37.5%) and other physician suspended treatment (31.3%). CONCLUSION 88.2% of patients with T2DM required lipid-lowering drugs. Education for patients and physicians is critical to achieve and maintain diabetes goals. TRIAL REGISTRATION NUMBER NCT02836808.
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Affiliation(s)
- Ana Cristina García-Ulloa
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Claudia Lechuga-Fonseca
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fabiola Mabel Del Razo-Olvera
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Alberto Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
- Dirección de Nutrición, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - K M Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Sergio Hernández-Jiménez
- Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Stock J. Targeting LDL cholesterol: Early treatment is key to population health. Atherosclerosis 2020; 300:37-38. [PMID: 32253009 DOI: 10.1016/j.atherosclerosis.2020.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Jane Stock
- European Atherosclerosis Society, World Trade Center Göteborg, Mässans Gata 10, SE-412 51, Göteborg, Sweden.
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