Better lipid target achievement for secondary prevention through disease management programs for diabetes mellitus and coronary heart disease in clinical practice in Germany

Gitt, Anselm K.; Sonntag, Frank; Jannowitz, Christina; Weizel, Achim; Karmann, Barbara; Schaefer, Juergen R.; Pittrow, David; Hildemann, Steven

doi:10.1185/03007995.2015.1120715

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…The impact of Germany’s statutory health insurance disease management programs (DMP) for diabetes mellitus and coronary heart disease on attainment of lipid-lowering goals has been assessed using data obtained in the prospective, non-interventional LIMA (Leitliniengerechte Lipidtherapie und Zielwerterreichung bei Risikopatienten im klinischen Alltag) study. In this secondary prevention population of 12,154 adults, 7–10% attained the < 70 mg/dL LDL-C goal at any point during a 12-month follow-up [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns and low-density lipoprotein cholesterol (LDL-C) goal attainment among patients receiving high- or moderate-intensity statins

Fox

Tai

Kostev³

et al. 2017

Clin Res Cardiol

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BackgroundEuropean clinical guidelines recommend a low-density lipoprotein cholesterol (LDL-C) goal of < 70 mg/dL. Statin use varies and past studies suggest low rates of real-world goal attainment. This study describes LDL-C goal attainment among atherosclerotic CV disease (ASCVD) patients with various utilization patterns of moderate- or high-intensity statins in routine care.MethodsThis retrospective cohort study used electronic medical records data from the QuintilesIMS® Disease Analyzer (> 2 million individuals annually) to identify ASCVD (coronary atherosclerosis, stable/unstable angina, myocardial infarction, ischemic stroke, transient ischemic attack, aneurysm, peripheral artery disease) patients on moderate-/high-intensity statin in Germany. Proportion of patients with LDL-C < 70 mg/dL was determined using the lowest LDL-C value for each patient (index) in 2012, 2013, and 2014, while on statin. Treatment patterns were assessed for patients with at least 1 year of post-index follow-up. Results were stratified by year and treatment pattern [no change, switch, dose up-/down-titration, discontinuation (≥ 90 day gap)].ResultsIn > 14,000 patients assessed in each year (mean age 71 years, 35% female, 8–12% taking high-intensity statins), approximately 80% had LDL-C ≥ 70 mg/dL. Treatment patterns were assessed for most (88–93%) patients. Approximately 79–81% of patients made no change to statin regimens, 1% switched statins, 14–16% discontinued; 1% of moderate-intensity patients up-titrated, and 3% of all patients down-titrated. LDL-C goal attainment in these treatment pattern groups was 20, 16–24, 17, 11–14, and 17–19%, respectively.ConclusionsMajority of ASCVD patients had LDL-C ≥ 70 mg/dL while on moderate-/high-intensity statins. Despite low LDL-C goal attainment, few patients changed their treatment regimens.Electronic supplementary materialThe online version of this article (10.1007/s00392-017-1193-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Treatment patterns and low-density lipoprotein cholesterol (LDL-C) goal attainment among patients receiving high- or moderate-intensity statins

Fox

Tai

Kostev³

et al. 2017

Clin Res Cardiol

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“…39 Regarding patients with diabetes, there is one report from Germany for better lipid goal achievement for secondary prevention in patients with and without diabetes and coronary heart disease participating in disease management programmes (DMP). 40…”

Section: Discussionmentioning

confidence: 99%

Low‐density lipoprotein cholesterol and non‐high‐density lipoprotein cholesterol in type 1 diabetes and type 2 diabetes: Lipid goal attainment in a large German–Austrian diabetes registry

Brandts,

Tittel,

Bramlage

et al. 2023

Diabetes Obesity Metabolism

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AimTo assess the implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline recommendations for lipid‐lowering therapies among more than 30 000 patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) in a German and Austrian registry from 2020 to 2022.Materials and MethodsRegistry data from 2020 and 2021 of 32 170 adult patients (8314 patients with T1D and 23 856 with T2D) were stratified according to the 2019 ESC/EAS risk categories, and guideline‐based low‐density lipoprotein cholesterol (LDL‐C) and non‐high‐density lipoprotein cholesterol (non‐HDL‐C) goal attainment was analysed.ResultsIn patients with T1D (median age 38.35 [20.51‐57.13] years), overall statin use was 19.3%, ezetimibe use was 2.2% and the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or fibrates was less than 1%. In patients with T2D (median age 68.76 [58.86‐78.39] years), 45.7% received statins, 3.4% received ezetimibe, and fibrates and PCSK9 inhibitors were used by 1% and 0.1%, respectively. Among patients with T1D, 6.16% reached their risk‐based recommended LDL‐C goal of less than 55 mg/dL (very high risk), 10.97% of less than 70 mg/dL (high risk), and 69.50% of less than 100 mg/dL (moderate risk), respectively. In patients with T2D, 11.81% reached their risk‐based goal of LDL‐C less than 55 mg/dL, 16.25% of less than 70 mg/dL, and 51.33% of less than 100 mg/dL. Non‐HDL‐C goals were reached more often, with 15.3%, 25.52% and 91.61% in patients with T1D and 18.56%, 17.96% and 82.30% in patients with T2D for very high, high and moderate risk, respectively.ConclusionApproximately 2 years after publication of the guidelines, LDL‐C and non‐HDL‐C goal attainment was rarely achieved in patients with T1D and T2D with a high or very high cardiovascular risk.

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“…In Germany, dyslipidaemia management practices and LDL-C goal attainment have been widely studied over the years in different datasets and from various perspectives, such as general practice of dyslipidaemia management, cardiac rehabilitation, or familial hypercholesterolaemia. Germany participated in the Dyslipidaemia International Study (DYSIS) I [ 25 ] and DYSIS II [ 14 , 15 , 26 ], and has extensive data from the post-MI cardiac rehabilitation-focussed PATIENT CARE registry [ 16 ], the familial hypercholesterolemia CaRe High registry [ 17 ], and other large datasets [ 18 , 27 ]. Even though these studies included very different patient populations, there was a consistent finding that LDL-C goal attainment is suboptimal, irrespective of the LDL-C goals recommended at the time by the ESC/EAS guidelines.…”

Section: Discussionmentioning

confidence: 99%

Low-density lipoprotein cholesterol goal attainment in Germany: Results from the DA VINCI study

Gouni‐Berthold

Schäper²,

Schatz

et al. 2022

Atherosclerosis Plus

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Better lipid target achievement for secondary prevention through disease management programs for diabetes mellitus and coronary heart disease in clinical practice in Germany

Abstract: Patients in DMP compared to those not in DMP achieved better LDL-C lowering and higher control rates, but overall lipid target achievement rates need to be improved. Longer-term observations are needed to corroborate these findings.

Cited by 8 publications

References 14 publications

Treatment patterns and low-density lipoprotein cholesterol (LDL-C) goal attainment among patients receiving high- or moderate-intensity statins

Treatment patterns and low-density lipoprotein cholesterol (LDL-C) goal attainment among patients receiving high- or moderate-intensity statins

Low‐density lipoprotein cholesterol and non‐high‐density lipoprotein cholesterol in type 1 diabetes and type 2 diabetes: Lipid goal attainment in a large German–Austrian diabetes registry

Low-density lipoprotein cholesterol goal attainment in Germany: Results from the DA VINCI study

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