Clinicians slow to address CV risk factors in type 2 diabetes
medwireNews: People with type 2 diabetes, particularly those diagnosed at a young age, can face an extended wait for medication to treat cardiovascular (CV) risk factors, even if they are in a high-risk category, research shows.
“This resulted in very high probability of clinically unacceptable blood pressure and lipid burden during disease progression at population level,” say Sanjoy Paul (University of Melbourne, Victoria, Australia) and study co-authors.
As reported in Diabetes, Obesity and Metabolism, the team identified 254,925 people with type 2 diabetes in the UK’s THIN primary care database.
At the point of diagnosis, 66% of the cohort overall had dyslipidemia, the same proportion had hypertension, and 46% had both risk factors. The prevalence in people younger than 50 years was 60% for dyslipidemia, 42% for hypertension, and 29% for both.
However, the team notes that the prevalence of dyslipidemia in the younger age group rose between study baseline in 2005 and 2016, whereas the rate of hypertension was relatively stable. Indeed, dyslipidemia prevalence rose in all age groups younger than 60 years.
Use of medications to control these risk factors increased between the point of diagnosis and 6 months later; however, people younger than 50 years were given these medications less often than older people were. For example, rates of lipid-lowering therapy among people with baseline dyslipidemia rose from 37% to 63% overall, but from 13% to 43% in the younger age group.
This was despite around 80% of the younger group being at high risk for atherosclerotic CV disease (ASCVD), defined as prevalent disease or at least two risk factors (smoking, obesity, hypertension and/or dyslipidemia, or microvascular disease).
Moreover, the median time to initiating medication among people not on it at baseline was only slightly less for high- versus low-risk people, at 10.8 versus 13.1 months for lipid-lowering therapy and 20.2 versus 22.2 months for antihypertensives.
And within the high-risk group, the time to initiating lipid-lowering or antihypertensive therapy was generally longer in younger people, with people younger than 40 years waiting a median of 20.4 months for lipid-lowering therapy and 28.1 months for antihypertensive therapy, compared with approximately 10 and 19 months, respectively, for the older age groups.
In line with these findings, people with dyslipidemia at baseline who did not start lipid-lowering therapy until a year or more later were 16–25% more likely than those who started sooner to have uncontrolled lipid levels over the following 2 years.
Likewise, people with hypertension who had a delayed start to antihypertensive medication had a 40–59% increased risk for continued uncontrolled blood pressure.
“It is particularly important to note here that those who are deemed to have low ASCVD risk at diagnosis and initiating therapy after one year in fact had higher probability of risk factor control failure compared with those who were deemed to have high ASCVD risk at baseline and initiating the therapy within one year of diagnosis,” say the researchers.
“This unique finding is reflected across all age groups,” they add, and suggest that current guidelines on risk stratification and pharmacologic intervention may need to be revised.
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