RESUMO
Stricter control of risk factors has been pursued as a compelling strategy to mitigate cardiovascular events (CVE) in type 2 diabetes (T2D) individuals. However, the achievement rate of the recommended goals has remained low in clinical practice. This study investigated the 2019 ESC guideline recommendation attainment among T2D individuals enrolled in a national cohort held in Brazil. Data from 1030 individuals (mean age: 58 years old; 54% male; mean T2D duration: 9.7 years) were analyzed. The control rates were 30.6% for SBP, 18.8% for LDL-C, and 41% for A1c, and only 3.2% of the study participants met all three targets. Statins and high-intensity lipid-lowering therapy prescription rates were 45% and 8.2%, respectively. Longer T2D duration and those at higher CV risk were less likely to be controlled. Longer diabetes duration and higher CV risk were inversely related to the chance of achieving the recommended targets. Treatment escalation using conventional therapies would be sufficient to gain optimal control in most of the study sample. In conclusion, a minimal proportion of T2D individuals comply with guidelines-oriented CV prevention targets. Given the significant burden of the disease, and the substantial effect size predicted for these therapies, bridging this gap between guidelines and clinical practice should be considered an urgent call to public health managers.
RESUMO
BACKGROUND: Cardiovascular disease (CVD) is one of the leading causes of death among people with diabetes, however, despite the increasing incidence of CVD, there are few tools for evaluating Cardiovascular Risk (CVR) in the population of patients with Type 1 Diabetes (T1D), with the existing ones diverging in the stratification of risk and in the suggestions for therapeutic conduct. METHODS: A cross-sectional study was carried out with 104 participants diagnosed with T1D, aged 18-40, attending specialized services. The Steno Type 1 Risk Engine and the Cardiovascular Risk Stratification Calculator (CRSC) were used to assess the risk of a cardiovascular event over a 10-year period. FINDINGS: Of the total sample selected, 62% were female, with a median age of 32 years (IQ 24; 43). There was a large difference between the stratification of CVR between the calculators, and 65.82% of the patients classified as low risk for CVD according to the Steno were identified as intermediate (30, 38.00%) and high risk (35.44%) by the CRSC. The analysis also highlighted a great difference in eligibility for statin use according to the risk stratification of the tools. CONCLUSION: The CRSC and Steno tools evaluated and stratified the CVR of the same population with T1D, with there being divergence of the results. It was found that the CRSC tool classified the majority of the sample as high risk. Due to this result, the eligibility to use statins, which is one of the applications of these tools, showed great differences, with the Steno tool presenting less aggressive provisions regarding the prescription of statins in patients with type 1 DM.