Lipid abnormalities ‘common’ among statin-treated diabetics
MedWire News: Statin-treated patients with diabetes often continue to have lipid abnormalities despite clinical evidence, guidelines, and recommendations supporting the benefits of intensifying treatment with lipid-modifying therapies, report researchers.
Over 40% of diabetic patients on statins did not have optimal low-density lipoprotein (LDL) cholesterol levels, and only a quarter achieved all three lipid goals (triglycerides, LDL, and high-density lipoprotein [HDL] cholesterol), as defined by the International Diabetes Federation criteria, remark Lawrence Leiter (University of Toronto, Ontario, Canada) and colleagues.
The researchers performed a secondary analysis of the Dyslipidemia International Study (DYSIS).The DYSIS cohort included over 22,000 statin-treated outpatients from 2954 sites across 11 European countries. Individuals were eligible for inclusion if they had been receiving statin therapy for 3 months or more, were 45 years or older, and had at least one lipid measurement available, taken while receiving statin therapy.
In all, 5.5% (n=1099) of patients had diabetes, 35.8% (n=7213) had diabetes and the metabolic syndrome (defined by the International Diabetes Federation criteria), 29.8% (n=5993) had the metabolic syndrome only, and 28.9% (n=5824) were free from the metabolic syndrome and diabetes.
Regardless of their metabolic syndrome status, 41% of patients with diabetes were not at LDL cholesterol goals and 48% were not at total cholesterol targets.
Of note, the percentage of patients not at goal was even higher among those who did not have diabetes but had the metabolic syndrome, and among those who presented with neither of these conditions, at 54% and 52% for LDL cholesterol and 59% and 58% for total cholesterol, respectively.
The researchers speculate that this may be a reflection of better lipid-focused treatment once a patient is diagnosed with diabetes.
However, of the nearly half (45.2%) of diabetes patients who also presented with CVD , two-fifths were not at optimal LDL cholesterol levels, and only a quarter achieved all three lipid goals.
The research group says: "The increasing complexity of many guidelines, coupled with recommendations based on varying strengths of evidence, may limit the motivations of some physicians to initiate and continue more aggressive therapeutic strategies.
"Suboptimal patient compliance towards typical and increasing dosages of statins, as well as the perceived complexity of combination therapy, may also in part factor into poor lipid goal achievements."
Leiter et al conclude: "There is room to optimize therapy through statin dose up-titration and/or addition of other lipid-modifying therapies."
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By Nikki Withers