Control de factores de riesgo cardiovascular en pacientes diabéticos revascularizados: un subanálisis del estudio ICP- Bypass / Control of cardiovascular risk factors in revascularized patients with diabetes: A subanalysis of the ICP-bypass study

Introducción y objetivos Los diabéticos tipo 2 con enfermedad coronaria revascularizada son un grupo de muy alto riesgo cardiovascular poco estudiado. Este subanálisis del estudio ICP-Bypass analiza sus características clínicas y el control de factores de riesgo. Métodos Se seleccionó a los diabéticos tipo 2 procedentes de un estudio previo multicéntrico, observacional y transversal (ICP-Bypass) realizado en 2.293 pacientes > 18 años sometidos a cirugía coronaria o intervencionismo coronario percutáneo. Se recogieron y analizaron de manera comparativa variables demográficas y terapéuticas, así como los parámetros clínicos y analíticos. Resultados La edad media ± desviación estándar de los 771 diabéticos fue 67,7 ± 9,6 años (el 71,4% varones; tiempo medio desde la revascularización, 3,5 años). La mayoría (57,8%) recibía tratamiento con antidiabéticos orales solos y el 30,4% recibían insulina sola o combinada. La media de glucohemoglobina fue del 7,1% (en el 70%, < 7,5%). El 74,8% tenía diagnóstico de dislipemia. El colesterol unido a lipoproteínas de baja densidad medio fue 93,5 mg/dl (el 73%, > 70 mg/dl). Se administraban estatinas al 93,6 y el 18,7% recibía una estatina combinada con ezetimiba. Del 78,1% con diagnóstico de hipertensión, el 52% tenía presión arterial sistólica/diastólica < 130/80 mmHg y el 93%, < 140/90 mmHg. Conclusiones En el manejo del riesgo y la prevención cardiovascular de los pacientes diabéticos revascularizados en España se observa margen de mejora en el control de factores de riesgo, fundamentalmente la dislipemia. La existencia de pacientes con glucohemoglobina > 7,5% requeriría la evaluación individual de los objetivos de control glucémico (AU)

Introduction and objectives Patients with type 2 diabetes and revascularized coronary disease are a group with very high cardiovascular risk that has been rarely studied. This ICP-Bypass substudy analyzes the clinical characteristics and risk factor control of these patients. Methods The analysis selected patients with type 2 diabetes who had participated in an earlier multicenter, observational, cross-sectional study (ICP-Bypass) conducted in 2293 patients > 18 years of age who had undergone coronary surgery or percutaneous coronary intervention. Demographic and therapeutic variables, as well as clinical and analytical parameters, were collected and comparatively analyzed. Results The mean age (standard deviation) of the 771 diabetic patients included in the analysis was 67.7 (9.6) years (71.4% men; mean time since revascularization, 3.5 years). Most (57.8%) were receiving treatment with oral hypoglycemics alone, whereas 30.4% were receiving insulin alone or in combination. The mean glycohemoglobin figure was 7.1% (in 70%, < 7.5%); 74.8% had been diagnosed with dyslipidemia. Mean low-density lipoprotein cholesterol was 93.5 mg/dL (in 73%, > 70 mg/dL). Among these patients, 93.6% were receiving statins and 18.7% a statin combined with ezetimib. A total of 78.1% had been diagnosed with hypertension; systolic/diastolic blood pressure was < 130/80 mmHg in 52% and < 140/90 mmHg in 93%.ConclusionsCardiovascular risk and prevention may be improved in revascularized diabetic patients in Spain through further control of risk factors, particularly dyslipidemia. Patients with glycohemoglobin > 7.5% should be individually assessed in terms of glycemic targets (AU)

Control of cardiovascular risk factors in revascularized patients with diabetes: a subanalysis of the ICP-Bypass study.

INTRODUCTION AND OBJECTIVES: Patients with type 2 diabetes and revascularized coronary disease are a group with very high cardiovascular risk that has been rarely studied. This ICP-Bypass substudy analyzes the clinical characteristics and risk factor control of these patients. METHODS: The analysis selected patients with type 2 diabetes who had participated in an earlier multicenter, observational, cross-sectional study (ICP-Bypass) conducted in 2293 patients > 18 years of age who had undergone coronary surgery or percutaneous coronary intervention. Demographic and therapeutic variables, as well as clinical and analytical parameters, were collected and comparatively analyzed. RESULTS: The mean age (standard deviation) of the 771 diabetic patients included in the analysis was 67.7 (9.6) years (71.4% men; mean time since revascularization, 3.5 years). Most (57.8%) were receiving treatment with oral hypoglycemics alone, whereas 30.4% were receiving insulin alone or in combination. The mean glycohemoglobin figure was 7.1% (in 70%,<7.5%); 74.8% had been diagnosed with dyslipidemia. Mean low-density lipoprotein cholesterol was 93.5 mg/dL (in 73%, > 70 mg/dL). Among these patients, 93.6% were receiving statins and 18.7% a statin combined with ezetimib. A total of 78.1% had been diagnosed with hypertension; systolic/diastolic blood pressure was < 130/80 mmHg in 52% and < 140/90 mmHg in 93%. CONCLUSIONS: Cardiovascular risk and prevention may be improved in revascularized diabetic patients in Spain through further control of risk factors, particularly dyslipidemia. Patients with glycohemoglobin > 7.5% should be individually assessed in terms of glycemic targets.

Cholesterol control according to the presence of metabolic syndrome in coronary and diabetic patients. Relationship with non-alcoholic fatty liver disease.

BACKGROUND AND AIMS: Metabolic syndrome (MS) is an association of cardiovascular risk factors that increases the risk of coronary disease or type 2 diabetes mellitus (DM2), and has also been associated with the presence of liver steatosis (LS). In this study the relation of MS and LS with cholesterol control was analyzed in very high cardiovascular risk patients (coronary patients and/or DM2). METHODS: A cross-sectional epidemiological study including 6988 patients, from whom information was obtained on their characteristics, lipid profile and treatments. RESULTS: 4455 patients (65%) of the total study population had MS. Of MS criteria, high BP was the criterion most represented in the total population, while high TGs was the least. Within the total population, coronary patients showed a greater proportion of high BP, high TG and low HDL-c than those without coronary disease. Although no influence of MS was seen on the achievement of LDL-c targets (<70 mg/dL), the presence of high BP, high blood glucose and low HDL-c was related to poorer control of LDL-c. Finally, patients with MS showed a greater proportion of liver steatosis and this was associated in turn with poorer control of LDL-c. CONCLUSIONS: The criteria for MS are closely related to cholesterol control. LS is more prevalent in patients with MS, and it is associated with poorer control of LDL-c. We should focus on the presence of MS in high and very high CV risk patients in order to improve their lipid control.

Dislipemia en población diabética tratada con estatinas. Resultados del estudio DYSIS en España / Dyslipemia in diabetics treated with statins. Results of the dysis study in spian

Fundamento y objetivo: La diabetes mellitus tipo 2 (DM2) se asocia con un elevado riesgo cardiovascular (RCV), siendo de gran importancia tratar intensivamente los distintos factores de RCV, como la dislipemia. El tratamiento hipocolesterolemiante es necesario para conseguir reducir el RCV asociado a la DM2, siendo el colesterol unido a lipoproteínas de baja densidad (colesterol LDL) el principal objetivo terapéutico. En este trabajo se analiza el perfil lipídico de pacientes diabéticos en tratamiento con estatinas. Pacientes y método: El estudio DYSIS (Dyslipidemia International Study) es un estudio observacional, internacional, en el que se analiza el perfil lipídico de pacientes tratados con estatinas, en prevención primaria o secundaria. Resultados: De los 3703 pacientes analizados, el 39% eran diabéticos. El 59,2% de los diabéticos presentaban el colesterol LDL fuera de control. En conjunto, el 43,6% de diabéticos presentaba triglicéridos elevados y el 36,4% tenían el colesterol unido a lipoproteínas de alta densidad (colesterol HDL) bajo. De los pacientes con cardiopatía isquémica y diabetes, el 31% tenían colesterol LDL, colesterol HDL y triglicéridos fuera de control. De los pacientes diabéticos con síndrome metabólico el 60% tiene el colesterol LDL fuera de objetivos, el 39,8% tienen el colesterol HDL bajo y el 46,6% triglicéridos elevados. El 57% de los pacientes diabéticos obesos presentaba falta de control del colesterol LDL, aún en tratamiento con estatinas. Conclusiones: Las enfermedades cardiovasculares son la primera causa de morbimortalidad en pacientes con DM2. El estudio DYSIS muestra que la mayoría de los pacientes tratados con estatinas no alcanzan los objetivos lipídicos recomendados por las guías. En el presente estudio se constata que más de la mitad de los diabéticos tratados con estatinas tiene el colesterol LDL fuera de control, el grado de control de la dislipemia es muy limitado a pesar del tratamiento con estatinas, lo que puede determinar la necesidad de una terapia combinada para el tratamiento eficaz de la dislipemia diabética (AU)

Background and objective: Type 2 diabetes mellitus (DM2) is characterized by carrying a high cardiovascular risk (CVR). This situation underscores the importance of intensively treating the risk factors present in diabetic patients, notably dyslipemia. The treatment with cholesterol-lowering drugs may be especially effective to reduce the CVR in diabetic patients. Therefore, low-density lipoproteins cholesterol (LDL-C) is a priority target in the lipid management of these patients. This study analyzes the alterations in the lipid profile of diabetic patients receiving treatment with statins, which therefore may contribute to persistent CVR in such individuals. Patients and methods: The Dyslipidemia International Study (DYSIS) is an international, observational trial analyzing the lipid profile of patients treated with statins and followed-up on in outpatient clinics by primary care physicians and specialists. This study is referred to the data on the diabetic patients. Results: Of the total patients enrolled in the DYSIS, the present study included 3,703 patients, 39% being diabetics. A total of 59.2% of diabetics showed LDL-C out of goal; triglyceride elevation was observed in 43.6% and 36.4% showed low high-density lipoproteins cholesterol (HDL-C). In diabetic patients with coronary heart disease, 31% had uncontrolled levels of all 3 lipid parameters. The prevalence of out of goal LDL-C in diabetic patients with metabolic syndrome was close to 60%; 39.8% had low levels of HDL-C and 46.6% high levels of triglycerides. In addition, 57% of diabetic patients with obesity showed LDL-C out of control, despite statins treatment. Conclusions: Cardiovascular diseases remain the main cause of morbimortality in patients with DM2. The results of the present study show that in diabetic patients the degree of control is very limited with regard to LDL-C. More than half of diabetic patients treated with statins had LDL-C out of goal. The level of dyslipidemia control was low, despite statins treatment. Therefore, the detection of atherogenic dyslipidemia may point to the advisability of using combination therapy for dyslipidemia in diabetic patients (AU)

[Dyslipemia in diabetics treated with statins. Results of the DYSIS study in Spian]. / Dislipemia en población diabética tratada con estatinas. Resultados del estudio DYSIS en España.

BACKGROUND AND OBJECTIVE: Type 2 diabetes mellitus (DM2) is characterized by carrying a high cardiovascular risk. This situation underscores the importance of intensively treating the risk factors present in diabetic patients, notably dyslipemia. The treatment with cholesterol-lowering drugs may be especially effective to reduce the cardiovascular risk in diabetic patients. Therefore, LDL-cholesterol is a priority target in the lipid management of these patients. This study analyzes the alterations in the lipid profile of diabetic patients receiving treatment with statins, which therefore may contribute to persistent cardiovascular risk in such individuals. PATIENTS AND METHODS: The DYSIS (Dyslipidemia International Study) is an international, observational trial analyzing the lipid profile of patients treated with statins and followed-up on in outpatient clinics by primary care physicians and specialists. This study is referred to the data on the diabetic patients. RESULTS: Of the total patients enrolled in the DYSIS, the present study included 3703 patients, 39% being diabetics. A total of 59.2% of diabetics showed LDL-C out of goal; triglyceride elevation was observed in 43.6% and 36.4% showed low HDL-C. In diabetics patients with coronary heart disease, 31% had uncontrolled levels of all three lipid parameters. The prevalence of out of goal LDL-C in diabetic patients with metabolic syndrome was close to 60%; 39.8% had low levels of HDL-C and 46,6% high levels of triglycerides. In addition, 57% of diabetic patients with obesity showed LDL-C out of control, despite statins treatment. CONCLUSIONS: Cardiovascular diseases remain the main cause of morbidity-mortality in patients with DM2. The results of the present study show that in diabetic patients the degree of control is very limited with regard to LDL-cholesterol. More than half of diabetic patients treated with statins had LDL-cholesterol out of goal. The level of dyslipidemia control was low, despite statins treatment. Therefore, the detection of atherogenic dyslipidemia may point to the advisability of using combination therapy for dyslipidemia in diabetic patients.

Magnitud y características del riesgo residual lipídico en pacientes con antecedentes de revascularización coronaria: estudio ICP- Bypass / Magnitude and characteristics of residual lipid risk in patients with a history of coronary revascularization: The ICP-Bypass study

Introducción y objetivos. El riesgo residual lipídico se define como el exceso de complicaciones cardiovasculares en pacientes con buen control del colesterol unido a liproteínas de baja densidad y se atribuye fundamentalmente al colesterol unido a lipoproteínas de alta densidad y los triglicéridos. El objetivo del estudio fue describir la magnitud y las características asociadas al riesgo residual lipídico en pacientes con antecedentes de revascularización coronaria. Métodos. Estudio multicéntrico, transversal y observacional. Se definió riesgo residual lipídico por la presencia de colesterol unido a lipoproteínas de alta densidad < 40mg/dl y/o triglicéridos > 150mg/dl en pacientes con colesterol unido a liproteínas de baja densidad < 100mg/dl. Resultados. Se incluyó a 2.292 pacientes, con una media de edad de 65,5±12,4 años. El 94,1% estaba en tratamiento con estatinas y el 4,8% no recibía ningún tratamiento hipolipemiante; el tratamiento únicamente con estatinas (74%) fue la estrategia más común, seguida de la combinación con ezetimiba (17%). La prevalencia de colesterol unido a lipoproteínas de alta densidad < 40mg/dl fue del 35,8%; la de hipertrigliceridemia, del 38,9%, y la de colesterol unido a liproteínas de baja densidad > 100mg/dl, 44,9%. El 29,9% de los pacientes constituyeron el colectivo de riesgo residual lipídico. Estos pacientes presentaron un perfil clínico similar, salvo por una media de edad ligeramente inferior, más diabetes y sexo masculino. El análisis multivariable identificó asociación positiva de la diabetes y el sexo masculino con riesgo residual lipídico; diabetes, tabaquismo activo, sexo masculino y el tratamiento con fibratos se asociaron al colesterol unido a lipoproteínas de alta densidad < 40mg/dl; y diabetes, tabaquismo, obesidad abdominal y el tratamiento con fibratos, a la hipertrigliceridemia. Conclusiones. Casi una tercera parte de los pacientes con antecedentes de revascularización coronaria presentan colesterol unido a liproteínas de baja densidad < 100mg/dl y colesterol unido a lipoproteínas de alta densidad bajo y/o triglicéridos elevados en la práctica clínica diaria, el denominado riesgo residual lipídico (AU)

Introduction and objectives. Residual lipid risk has been defined as the excess of cardiovascular events observed in patients with adequate control of low-density lipoprotein cholesterol and has been mainly attributed to high-density lipoprotein cholesterol and triglycerides. The aim of our study was to describe the clinical features and the magnitude and characteristics associated with residual lipid risk in patients with a history of coronary revascularization. Methods. Multicenter, observational, cross-sectional study of patients with a history of coronary revascularization. Residual lipid risk was defined as the presence of high-density lipoprotein cholesterol <40 mg/dL and/or triglycerides >150 mg/dL in patients with low-density lipoprotein cholesterol <100 mg/dL. Results. We included 2292 patients with a mean age of 65.5 (12.4) years; 94.1% were receiving no statin therapy and 4.8% no lipid therapy. Statin-only therapy (74%) was the most common strategy, followed by combination with ezetimibe (17%). The prevalence of high-density lipoprotein cholesterol <40 mg/dL was 35.8%, hypertriglyceridemia 38.9%, and low-density lipoprotein cholesterol >100 mg/dL 44.9%; the residual lipid risk group included 29.9% of all patients. This patient group had a similar clinical profile except for slightly lower mean age, higher incidence of diabetes, and higher proportion of men. Multivariate analysis identified positive associations of diabetes and male sex with residual lipid risk; current smoking, male sex, and fibrate therapy were associated with high-density lipoprotein cholesterol <40 mg/dL; current smoking, abdominal obesity, and fibrate therapy were associated with hypertriglyceridemia. Conclusions. In daily clinical practice, almost one-third of patients with a history of coronary revascularization have low-density lipoprotein cholesterol <100 mg/dL plus low high-density lipoprotein cholesterol and/or hypertriglyceridemia, a concept known as residual lipid risk (AU)

[Magnitude and characteristics of residual lipid risk in patients with a history of coronary revascularization: the ICP-bypass study]. / Magnitud y características del riesgo residual lipídico en pacientes con antecedentes de revascularización coronaria: estudio ICP-Bypass.

INTRODUCTION AND OBJECTIVES: Residual lipid risk has been defined as the excess of cardiovascular events observed in patients with adequate control of low-density lipoprotein cholesterol and has been mainly attributed to high-density lipoprotein cholesterol and triglycerides. The aim of our study was to describe the clinical features and the magnitude and characteristics associated with residual lipid risk in patients with a history of coronary revascularization. METHODS: Multicenter, observational, cross-sectional study of patients with a history of coronary revascularization. Residual lipid risk was defined as the presence of high-density lipoprotein cholesterol <40 mg/dL and/or triglycerides >150 mg/dL in patients with low-density lipoprotein cholesterol <100 mg/dL. RESULTS: We included 2292 patients with a mean age of 65.5 (12.4) years; 94.1% were receiving no statin therapy and 4.8% no lipid therapy. Statin-only therapy (74%) was the most common strategy, followed by combination with ezetimibe (17%). The prevalence of high-density lipoprotein cholesterol <40 mg/dL was 35.8%, hypertriglyceridemia 38.9%, and low-density lipoprotein cholesterol >100 mg/dL 44.9%; the residual lipid risk group included 29.9% of all patients. This patient group had a similar clinical profile except for slightly lower mean age, higher incidence of diabetes, and higher proportion of men. Multivariate analysis identified positive associations of diabetes and male sex with residual lipid risk; current smoking, male sex, and fibrate therapy were associated with high-density lipoprotein cholesterol <40 mg/dL; current smoking, abdominal obesity, and fibrate therapy were associated with hypertriglyceridemia. CONCLUSIONS: In daily clinical practice, almost one-third of patients with a history of coronary revascularization have low-density lipoprotein cholesterol <100 mg/dL plus low high-density lipoprotein cholesterol and/or hypertriglyceridemia, a concept known as residual lipid risk.

Prevalencia y características de la dislipemia en pacientes en prevención primaria y secundaria tratados con estatinas en España. Estudio DYSIS-España / Prevalence and characteristics of lipid abnormalities in patients treated with statins in primary and secondary prevention in Spain. DYSIS-Spain study

Introducción y objetivos. Los pacientes con alto riesgo de sufrir eventos cardiovasculares requieren tratamiento médico para optimizar su perfil lipídico. Dentro del estudio internacional DYSIS, se evaluaron las alteraciones del perfil lipídico de pacientes tratados con estatinas en España. Métodos. DYSIS es un estudio multinacional y transversal llevado a cabo en Canadá y Europa (n = 22.063). En España se incluyó a 3.710 pacientes tratados con estatinas durante al menos 3 meses. Se compararon los datos demográficos y el perfil de riesgo cardiovascular. Resultados. Se obtuvo el perfil lipídico de 3.617 pacientes. De los pacientes con alto riesgo cardiovascular con perfil lipídico completo (n = 2.273), el 78,9% presentaba concentraciones alteradas de alguno de los tres parámetros lipídicos principales: colesterol de las lipoproteínas de baja densidad (cLDL), colesterol de las lipoproteínas de alta densidad (cHDL) y/o triglicéridos. Dentro de este grupo, el cLDL no se encontraba en objetivo en el 61,4%, el cHDL estaba por debajo de lo normal en el 25,3% y los triglicéridos estaban elevados en el 37,8%. En general, el cLDL se encontraba fuera de objetivo en el 63,1% y sólo el 20,7% (n = 668) presentaba concentraciones normales o las recomendadas para los tres parámetros. Conclusiones. La mayoría de los pacientes tratados con estatinas, sobre todo aquellos con alto riesgo cardiovascular, no alcanzan los objetivos propuestos por las guías para los parámetros lipídicos. Aunque se deberá esperar a los resultados finales de estudios actuales sobre el uso de tratamientos combinados modificadores de lípidos, el manejo de los lípidos en España es mejorable (AU)

Introduction and objectives. Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study. Methods. DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n=22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile. Results. Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n=2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n=668) of those treated with statins were normal for all parameters. Conclusions. Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement (AU)

[Prevalence and characteristics of lipid abnormalities in patients treated with statins in primary and secondary prevention in Spain. DYSIS-Spain Study]. / Prevalencia y características de la dislipemia en pacientes en prevención primaria y secundaria tratados con estatinas en España. Estudio DYSIS-España.

INTRODUCTION AND OBJECTIVES: Patients at high risk of suffering cardiovascular events require medical treatment to optimize their lipid profile. The present analysis evaluates the lipid profiles among Spanish patients receiving statin therapy in the international DYSIS study. METHODS: DYSIS is a multinational cross-sectional study carried out in Canada and Europe (n=22,063). In Spain, 3710 patients treated with statin therapy for at least 3 months were included. We compared data relating to demographic parameters and cardiovascular risk profile. RESULTS: Complete lipid profiles of 3617 patients were recorded. Regarding the high cardiovascular risk patients with complete lipid profiles (n=2273), 78.9% had a disorder in at least one of the three main lipid parameters: low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and/or triglycerides. LDLc was not within target levels in 61.4% of these high risk patients; HDLc was abnormal in 25.3%, and triglycerides were elevated in 37.8%. Overall, LDLc was outside the target range in 63.1%, and 20.7% (n = 668) of those treated with statins were normal for all parameters. CONCLUSIONS: Most patients in this study who received statin therapy, particularly those at high cardiovascular risk, were not at the normal lipid parameter levels according to cardiovascular guidelines. Although it is necessary to wait for the final results of current studies on the use of combined lipid-modifying treatments, the management of lipid levels in Spain still has potential for improvement.

Coronary heart disease and dyslipidemia: a cross-sectional evaluation of prevalence, current treatment, and clinical control in a large cohort of Spanish high-risk patients: the PRINCEPS study.

The authors assessed a large cohort of patients with coronary heart disease (CHD) or at high risk for developing CHD in terms of lipid profile, lipid-lowering treatment, and attainment of National Cholesterol Education Program (NCEP) target low-density lipoprotein cholesterol (LDL-C) levels. The investigation was a cross-sectional study involving Spanish outpatients treated in primary or secondary care facilities. From a total of 26,598 attending patients, 12,128 with CHD or CHD risk equivalents were recruited by 1875 physicians; 49% had CHD and 69% had multiple risk factors. Only 25% of patients attained LDL-C values <100 mg/dL, 76.6% patients received lipid-lowering therapy (statins in 95.4% of cases), and 54% of physicians considered that a treatment change was required (the most frequent choice was the addition of ezetimibe to current statin therapy). In this large cohort of high-risk coronary patients, only 25% attained a target LDL-C of <100 mg/dL. These results highlight a need for improved patient care and physician awareness/training.