Current Status of Low-Density Lipoprotein Cholesterol Target Achievement in Patients with Type 2 Diabetes Mellitus in Korea Compared with Recent Guidelines

Abstract

Background: We evaluated the achievement of low-density lipoprotein cholesterol (LDL-C) targets in patients with type 2 diabetes mellitus (T2DM) according to up-to-date Korean Diabetes Association (KDA), European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS), and American Diabetes Association (ADA) guidelines. Methods: This retrospective cohort study collected electronic medical record data from patients with T2DM (≥20 years) managed by endocrinologists from 15 hospitals in Korea (January to December 2019). Patients were categorized according to guidelines to assess LDL-C target achievement. KDA (2019): Very High-I (atherosclerotic cardiovascular disease [ASCVD]) <70 mg/dL; Very High-II (target organ damage [TOD], or cardiovascular risk factors [CVRFs]) <70 mg/dL; high (others) <100 mg/dL. ESC/EAS (2019): Very High-I (ASCVD): <55 mg/dL; Very High-II (TOD or ≥3-CVRF) <55 mg/dL; high (diabetes ≥10 years without TOD plus any CVRF) <70 mg/dL; moderate (diabetes <10 years without CVRF) <100 mg/dL. ADA (2019): Very High-I (AS-CVD); Very High-II (age ≥40+ TOD, or any CVRF), for high intensity statin or statin combined with ezetimibe.Results: Among 2,000 T2DM patients (mean age 62.6 years; male 55.9%; mean glycosylated hemoglobin 7.2%) ASCVD prevalence was 24.7%. Of 1,455 (72.8%) patients treated with statins, 73.9% received monotherapy. According to KDA guidelines, LDL-C target achievement rates were 55.2% in Very High-I and 34.9% in Very High-II patients. With ESC/EAS guidelines, target attainment rates were 26.6% in Very High-I, 15.7% in Very High-II, and 25.9% in high risk patients. Based on ADA guidelines, most patients (78.9%) were very-high risk; however, only 15.5% received high-intensity statin or combination therapy.

Lipid Management in Korean People With Type 2 Diabetes Mellitus: Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis Consensus Statement

“…According to the Diabetes Fact Sheet 2021 of the KDA, 76.5% of Korean adults with diabetes had hyper-LDL-cholesterolemia, and only 38.3% of adults achieved the target level of LDL-C (<100 mg/dL). 22 In a recent retrospective observational study using electronic medical record data of 2,000 T2DM patients at 15 hospitals, LDL-C goal achievement remained suboptimal according to several current guidelines for dyslipidemia management 23 : 34.9%–55.2% in very high-risk patients according to the KDA guidelines, 24 15.7%–26.6% according to the ESC and EAS guidelines, 20 and only 15.5% according to the American Diabetes Association guidelines. 25 In a study using the Korean NHIS database including approximately 153,000 patients with diabetes, LDL-C goal attainment rates were 32.6% in patients without a high risk of CVD (<100 mg/dL) and 12.2% in patients with a high risk of CVD (<70 mg/dL).…”

Lipid Management in Korean People with Type 2 Diabetes Mellitus: Korean Diabetes Association and Korean Society of Lipid and Atherosclerosis Consensus Statement

“…According to the Diabetes Fact Sheet 2021 of the KDA, 76.5% of Korean adults with diabetes had hyper-LDL-cholesterolemia, and only 38.3% of adults achieved the target level of LDL-C (<100 mg/dL) [ 22 ]. In a recent retrospective observational study using electronic medical record data of 2,000 T2DM patients at 15 hospitals, LDL-C goal achievement remained suboptimal according to several current guidelines for dyslipidemia management [ 23 ]: 34.9% to 55.2% in very high-risk patients according to the KDA guidelines [ 24 ], 15.7% to 26.6% according to the ESC and EAS guidelines [ 20 ], and only 15.5% according to the American Diabetes Association guidelines [ 25 ]. In a study using the Korean NHIS database including approximately 153,000 patients with diabetes, LDL-C goal attainment rates were 32.6% in patients without a high risk of CVD (<100 mg/dL) and 12.2% in patients with a high risk of CVD (<70 mg/dL) [ 26 ].…”

Remnant cholesterol is an additional risk factor for cardiovascular disease beyond LDL cholesterol; Nationwide cohort study

“…Therefore, CVD-related mortality rates have improved over the past decades [2]. However, despite numerous efforts including a reduction in low-density lipoprotein cholesterol (LDL-C) by statin treatment, the substantial residual risk persists, with a majority of predicted rst and recurrent CVD events not being averted [3,4].…”

“…Therefore, CVD-related mortality rates have improved over the past decades [2]. However, despite numerous efforts including a reduction in low-density lipoprotein cholesterol (LDL-C) by statin treatment, the substantial residual risk persists, with a majority of predicted rst and recurrent CVD events not being averted [3,4].Atherogenesis is a chronic progressive disease fueled mainly by lipids [5]. Dyslipidemia has been long-recognized as a pivotal contributor to CVD, and circulating lipoprotein assessment is a core feature of both American and European guidelines for the primary and secondary prevention of CVD [6].…”