, Volkan Doğan 1
, Kadir Uğur Mert 2
, Bülent Özlek 1
, Eda Özlek 1
, Oğuzhan Çelik 1
, Cem Çil 3
, İbrahim Halil Özdemir 4
, İbrahim Rencüzoğulları 5
, Fatma Özpamuk Karadeniz 6
, Mehmet Tekinalp 7
, Lütfü Aşkın 8
, Selami Demirelli 9
, Erkan Gencer 10
, Lütfü Bekar 11
, Müjdat Aktaş 12
, Mübariz Murat Resulzade 13
, Macit Kalçık 11
, Gökhan Aksan 14
, Göksel Çinier 15
, Kadriye Halil Akay 16
, Nihat Pekel 17
, Gurbet Özge Mert 2
, Utku Şenol 18
, Vahit Demir 19
, Sinan İnci 20
, Emir Derviş 21
, Murat Biteker 1
, Meral Kayıkçıoğlu 22
2Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
3Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
4Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
5Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
6Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
7Department of Cardiology, Level Hospital, Zonguldak, Türkiye
8Department of Cardiology, Manisa City Hospital, Manisa, Türkiye
9Department of Cardiology, Kafkas University Faculty of Medicine, Kars, Türkiye
10Department of Cardiology, Büyükşehir Hospital, Konya, Türkiye
11Department of Cardiology, Necip Fazıl State Hospital, Kahramanmaraş, Türkiye
12Department of Cardiology, Adıyaman University Training and Research Hospital, Adıyaman, Türkiye
13Department of Cardiology, Kayseri City Hospital, Kayseri, Türkiye
14Department of Cardiology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Türkiye
15Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Türkiye
16Department of Cardiology, Arnavutköy State Hospital, İstanbul, Türkiye
17Department of Cardiology, Private Yüzyıl Hospital, İstanbul, Türkiye
18Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Türkiye
19Department of Cardiology, Samsun Training and Research Hospital, Samsun, Türkiye
20Department of Cardiology, Siyami Ersek Training and Research Hospital, İstanbul, Türkiye
21Department of Cardiology, Kocaeli State Hospital, Kocaeli, Türkiye
22Department of Cardiology, Tekden Private Hospital, Denizli, Türkiye
23Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
24Department of Cardiology, Eskişehir Acıbadem Hospital, Eskişehir, Türkiye
25Department of Cardiology, Yozgat City Hospital, Yozgat, Türkiye
26Department of Cardiology, Aksaray University Faculty of Medicine, Aksaray, Türkiye
27Department of Cardiology, Mehmet Akif Ersoy Training and Research Hospital, İstanbul, Türkiye
28Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
29Department of Cardiology, Ege University Faculty of Medicine, İzmir, Türkiye
Abstract
Background: The recent 2019 European Society of Cardiology/European Atherosclerosis Society practice guidelines introduced a new risk categorization for patients with diabetes. We aimed to compare the implications of the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines with regard to the lipid-lowering treatment use, low-density lipoprotein cholesterol goal attainment rates, and the estimated proportion of patients who would be at goal in an ideal setting.
Methods: Patients with diabetes were classified into 4 risk categories according to 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidemia guidelines from the database of EPHESUS (cross-sectional, observational, countrywide registry of cardiology outpatient clinics) study. The use of lipid-lowering treatment and low-density lipoprotein cholesterol goal attainment rates were then compared according to previous and new guidelines.
Results: This analysis included a total of 873 diabetic adults. Half of the study population (53.8%) were on lipid-lowering treatment and almost one-fifth (19.1%) were on high-intensity statins. While low-density lipoprotein cholesterol goal was achieved in 19.5% and 7.5% of patients, 87.4% and 69.6% would be on target if their lipid-lowering treatment was intensified according to 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society lipid guidelines, respectively. The new target <55 mg/dL could only be achieved in 2.2% and 8.1% of very high-risk primary prevention and secondary prevention patients, respectively.
Conclusion: The control of dyslipidemia was extremely poor among patients with diabetes. The use of lipid-lowering treatment was not at the desired level, and high-intensity lipid-lowering treatment use was even lower. Our simulation model showed that the high-dose statin plus ezetimibe therapy would improve goal attainment; however, it would not be possible to get goals with this treatment in more than one-third of the patients.