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

Abstract

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.

Secondary Cardiovascular Disease Prevention Deficit Persists over the Years: A Multicenter Cross-Sectional Study Involving 1003 Consecutive Patients from Greece

“…Of course, this is not a Greek paradox. Indeed, in a large German-Austrian cohort study of over 30,000 patients with diabetes, evaluated in 2020-2021 and stratified by their cardiovascular disease risk, the LDL goal of <70 mg/dL was achieved in 10.97% of patients with type 1 diabetes and 16.25% of patients with type 2 diabetes [8]. Even lower was the goal attainment of LDL-C < 55 mg/dL (6.16% and 11.81% for type 1 and type 2 diabetes respectively).…”

“…The use of higher intensity statins with the addition of ezetimibe and/or PCSK9 inhibitors (PCSK9i), inclisiran or lomitapide have allowed clinicians worldwide to be able to reduce the LDL-C according to the guidelines in many patients, if an adequate LDL-C-lowering medication strength is used. Despite the scientific progress and the wide availability of clinical practice guidelines, researchers in Greece [6,7] and globally [8][9][10][11][12][13] have reported poor outcomes with regard to LDL-C goals attainment in high-risk populations. In Greece specifically, the ease of access and the wide availability of most lipid-lowering treatment modalities for high-risk patients (statins, ezetimibe, PCSK9i, inclisiran) should have assisted in achieving these goals.…”