Achievement of the ESC recommendations for secondary prevention of cardiovascular risk factors in high-risk patients with type 2 diabetes: A real-world national cohort analysis.

Autor: Salem AM; Cardiology Department, Swansea Bay University Health Board, United Kingdom; Institute of Life Sciences-2, Swansea University Medical School, United Kingdom. Electronic address: dr.ahmedsalem11@hotmail.com., Harris D; Cardiology Department, Swansea Bay University Health Board, United Kingdom; Institute of Life Sciences-2, Swansea University Medical School, United Kingdom., Bray JJH; Institute of Life Sciences-2, Swansea University Medical School, United Kingdom., Obaid DR; Cardiology Department, Swansea Bay University Health Board, United Kingdom; Institute of Life Sciences-2, Swansea University Medical School, United Kingdom., Stephens JW; Institute of Life Sciences-2, Swansea University Medical School, United Kingdom; Department of Diabetes and Endocrinology, Swansea Bay University Health Board, United Kingdom., Halcox J; Cardiology Department, Swansea Bay University Health Board, United Kingdom; Institute of Life Sciences-2, Swansea University Medical School, United Kingdom.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2023 Apr 15; Vol. 377, pp. 104-111. Date of Electronic Publication: 2023 Feb 09.
DOI: 10.1016/j.ijcard.2023.02.004
Abstrakt: Aim: To assess compliance with European Society of Cardiology (ESC) secondary prevention recommendations in a nationwide contemporary population with diabetes mellitus (DM) and coronary artery disease.
Method: We conducted a retrospective observational study using linked health data in patients across Wales with DM undergoing percutaneous coronary intervention (2012-2017). The follow-up was for one year. We analysed the clinical characteristics, medications, target levels for HbA1c, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C) and blood pressure against the ESC prevention guidelines.
Results: Overall, 3478 patients with diabetes had available data at 1-year post-PCI. Only 43% had HbA1c levels <53 mmol/L, but 81% had blood pressure < 140/80 (current ESC targets). Prescribing frequency of the newer hypoglycaemic agents (glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter 2 inhibitors) was suboptimal, with a higher rate in patients with HbA1c ≥53 mmol/mol. Only 51% & 27% of the patients had LDL-C levels <1.8 &1.4 mmol/L (2016 & 2019 guidelines recommendations respectively), and 55% & 34% had non-HDL-C levels <2.6 & 2.2 mmol/L (2016 & 2019 guidelines respectively). Of the uncontrolled LDL-C patients, 42% (2016 target) and 35% (2019 target) were prescribed high-intensity statins. Females were more likely to have LDL-C targets above the recommended level.
Conclusion: Achievement of ESC treatment goals in this very-high risk cohort for DM and hyperlipidaemia was far from optimal, with a low prescription rate of the guidelines-recommended therapy. Target goals for hypertension were met more frequently. An up-to-date analysis reflecting the current practice against the most recent guidelines is warranted.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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