Las dislipidemias y su tratamiento en centros de alta complejidad en Colombia / Dyslipidaemias and their treatment in high complexity centres in Colombia

ANTECEDENTES Y OBJETIVO: Los datos sobre la distribución de las dislipidemias en Colombia son limitados. El objetivo primario de este estudio fue describir la frecuencia de las dislipidemias; los objetivos secundarios fueron: la frecuencia de comorbilidades cardiovasculares, el uso de estatinas y otros hipolipemiantes, la frecuencia de intolerancia a estatinas, el porcentaje de pacientes en metas de c-LDL, y estimar la distribución del riesgo cardiovascular (RCV). MATERIALES Y MÉTODOS: Estudio transversal con recolección de datos retrospectiva que incluyó a 461 pacientes con diagnóstico de dislipidemia tratados en 17 centros cardiovasculares de alta complejidad en las 6 principales áreas geográficas y económicas de Colombia. RESULTADOS: La media (DE) de edad de los pacientes incluidos fue de 66,4 (±12,3) años. El 53,4% (246) eran mujeres. Las dislipidemias se distribuyeron así: dislipidemia mixta (51,4%), hipercolesterolemia (41,0%), hipertrigliceridemia (5,4%), hipercolesterolemia familiar (3,3%) y c-HDL bajo (0,7%). El medicamento más prescrito fue atorvastatina (75,7%), seguido de rosuvastatina (24,9%). El 55% del total de pacientes y el 28,6% de aquellos con enfermedad coronaria no estaban en metas de c-LDL a pesar del tratamiento. La frecuencia de intolerancia a estatinas fue del 2,6%. CONCLUSIONES: La dislipidemia mixta y la hipercolesterolemia son las dislipidemias más frecuentes. Un porcentaje considerable de pacientes en tratamiento, incluidos aquellos con enfermedad coronaria, no lograron sus objetivos de c-LDL. Este inadecuado control lipídico influye en el RCV y requiere un cambio en las estrategias terapéuticas, intensificando el tratamiento con estatinas o adicionando nuevos fármacos en los pacientes con mayor RCV

BACKGROUND AND OBJECTIVE: Data is scarce on the distribution of different types of dyslipidaemia in Colombia. The primary objective was to describe the frequency of dyslipidaemias. The secondary objectives were: frequency of cardiovascular comorbidity, statins and other lipid-lowering drugs use, frequency of statins intolerance, percentage of patients achieving c-LDL goals, and distribution of cardiovascular risk (CVR). MATERIALS AND METHODS: Cross-sectional study with retrospective data collection from 461 patients diagnosed with dyslipidaemia and treated in 17 highly specialised centres distributed into six geographic and economic regions of Colombia. RESULTS: Mean (SD) age was 66.4 (±12.3) years and 53.4% (246) were women. Dyslipidaemias were distributed as follows in order of frequency: mixed dyslipidaemia (51.4%), hypercholesterolaemia (41.0%), hypertriglyceridaemia (5.4%), familial hypercholesterolaemia (3.3%), and low c-HDL (0.7%). The most prescribed drugs were atorvastatin (75.7%) followed by rosuvastatin (24.9%). As for lipid control, 55% of all patients, and 28.6% of those with coronary heart disease, did not achieve their personal c-LDL goal despite treatment. The frequency of statin intolerance was 2.6% in this study. CONCLUSIONS: Mixed dyslipidaemia and hypercholesterolaemia are the most frequent dyslipidaemias in Colombia. A notable percentage of patients under treatment with lipid-lowering drugs, including those with coronary heart disease, did not achieve specific c-LDL goals. This poor lipid control may worsen patient's CVR, so that therapeutic strategies need to be changed, either with statin intensification or addition of new drugs in patients with higher CVR

Dyslipidaemias and their treatment in high complexity centres in Colombia. / Las dislipidemias y su tratamiento en centros de alta complejidad en Colombia.

BACKGROUND AND OBJECTIVE: Data is scarce on the distribution of different types of dyslipidaemia in Colombia. The primary objective was to describe the frequency of dyslipidaemias. The secondary objectives were: frequency of cardiovascular comorbidity, statins and other lipid-lowering drugs use, frequency of statins intolerance, percentage of patients achieving c-LDL goals, and distribution of cardiovascular risk (CVR). MATERIALS AND METHODS: Cross-sectional study with retrospective data collection from 461 patients diagnosed with dyslipidaemia and treated in 17 highly specialised centres distributed into six geographic and economic regions of Colombia. RESULTS: Mean (SD) age was 66.4 (±12.3) years and 53.4% (246) were women. Dyslipidaemias were distributed as follows in order of frequency: mixed dyslipidaemia (51.4%), hypercholesterolaemia (41.0%), hypertriglyceridaemia (5.4%), familial hypercholesterolaemia (3.3%), and low c-HDL (0.7%). The most prescribed drugs were atorvastatin (75.7%) followed by rosuvastatin (24.9%). As for lipid control, 55% of all patients, and 28.6% of those with coronary heart disease, did not achieve their personal c-LDL goal despite treatment. The frequency of statin intolerance was 2.6% in this study. CONCLUSIONS: Mixed dyslipidaemia and hypercholesterolaemia are the most frequent dyslipidaemias in Colombia. A notable percentage of patients under treatment with lipid-lowering drugs, including those with coronary heart disease, did not achieve specific c-LDL goals. This poor lipid control may worsen patient's CVR, so that therapeutic strategies need to be changed, either with statin intensification or addition of new drugs in patients with higher CVR.

The potential impact of admission insulin levels on patient outcome in the intensive care unit.

BACKGROUND: Blood levels of insulin in patients with critical illness at admission to the intensive care unit (ICU) and its association with in-hospital mortality are not fully defined. Our objective was to determine this association in a cohort of patients with critical illness who attended in a mixed ICU. METHODS: Prospective cohort was nested in a randomized clinical trial conducted in a 12-bed mixed ICU in a tertiary hospital in Medellin (Colombia). One hundred sixty consecutively admitted patients, 15 years or older, were analyzed. Blood insulin and blood glucose levels were measured at admission to the ICU, as well as Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. A logistic regression model was created with in-hospital mortality as the outcome. RESULTS: In-hospital mortality was 57 (35.6%) of 160. Survivors had lower Acute Physiology and Chronic Health Evaluation II (median, 13 vs. 17) and lower insulin levels (median, 6.5 vs. 9 µU/mL) than did nonsurvivors. More women than men died (27 [48.2%] of 56 vs. 30 [28.8%] of 104), and 39% of the deaths (n = 22) occurred in patients with sepsis. Patients with insulin levels greater than 15 µU/mL had a higher mortality rate compared with patients with values of 5 µU/mL to 15 µU/mL (odds ratio, 3.57; 95% confidence interval, 1.18-10.8). CONCLUSION: At admission to the ICU, patients with critical illness showed hyperglycemia and relatively decreased insulin levels. High levels of insulin were independently associated with in-hospital mortality in this study population. LEVEL OF EVIDENCE: Prognostic study, level II.

Strict glycaemic control in patients hospitalised in a mixed medical and surgical intensive care unit: a randomised clinical trial.

INTRODUCTION: Critically ill patients can develop hyperglycaemia even if they do not have diabetes. Intensive insulin therapy decreases morbidity and mortality rates in patients in a surgical intensive care unit (ICU) and decreases morbidity in patients in a medical ICU. The effect of this therapy on patients in a mixed medical/surgical ICU is unknown. Our goal was to assess whether the effect of intensive insulin therapy, compared with standard therapy, decreases morbidity and mortality in patients hospitalised in a mixed ICU. METHODS: This is a prospective, randomised, non-blinded, single-centre clinical trial in a medical/surgical ICU. Patients were randomly assigned to receive either intensive insulin therapy to maintain glucose levels between 80 and 110 mg/dl (4.4 to 6.1 mmol/l) or standard insulin therapy to maintain glucose levels between 180 and 200 mg/dl (10 and 11.1 mmol/l). The primary end point was mortality at 28 days. RESULTS: Over a period of 30 months, 504 patients were enrolled. The 28-day mortality rate was 32.4% (81 of 250) in the standard insulin therapy group and 36.6% (93 of 254) in the intensive insulin therapy group (Relative Risk [RR]: 1.1; 95% confidence interval [CI]: 0.85 to 1.42). The ICU mortality in the standard insulin therapy group was 31.2% (78 of 250) and 33.1% (84 of 254) in the intensive insulin therapy group (RR: 1.06; 95%CI: 0.82 to 1.36). There was no statistically significant reduction in the rate of ICU-acquired infections: 33.2% in the standard insulin therapy group compared with 27.17% in the intensive insulin therapy group (RR: 0.82; 95%CI: 0.63 to 1.07). The rate of hypoglycaemia (< or = 40 mg/dl) was 1.7% in the standard insulin therapy group and 8.5% in the intensive insulin therapy group (RR: 5.04; 95% CI: 1.20 to 21.12). CONCLUSIONS: IIT used to maintain glucose levels within normal limits did not reduce morbidity or mortality of patients admitted to a mixed medical/surgical ICU. Furthermore, this therapy increased the risk of hypoglycaemia. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: 4374-04-13031; 094-2 in 000966421.