ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology
How Did the Updated 2019 European Society of Cardiology/European Atherosclerosis Society Risk Categorization for Patients with Diabetes Affect the Risk Perception and Lipid Goals? A Simulated Analysis of Real-life Data from EPHESUS Study [Anatol J Cardiol]
Anatol J Cardiol. 2023; 27(2): 78-87 | DOI: 10.14744/AnatolJCardiol.2022.2012

How Did the Updated 2019 European Society of Cardiology/European Atherosclerosis Society Risk Categorization for Patients with Diabetes Affect the Risk Perception and Lipid Goals? A Simulated Analysis of Real-life Data from EPHESUS Study

Özcan Başaran1, Volkan Doğan1, Kadir Uğur Mert2, Bülent Özlek1, Eda Özlek1, Oğuzhan Çelik1, Cem Çil3, İbrahim Halil Özdemir4, İbrahim Rencüzoğulları5, Fatma Özpamuk Karadeniz6, Mehmet Tekinalp7, Lütfü Aşkın8, Selami Demirelli9, Erkan Gencer10, Lütfü Bekar11, Müjdat Aktaş12, Mübariz Murat Resulzade13, Macit Kalçık11, Gökhan Aksan14, Göksel Çinier15, Kadriye Halil Akay16, Nihat Pekel17, Gurbet Özge Mert2, Utku Şenol18, Vahit Demir19, Sinan İnci20, Emir Derviş21, Murat Biteker1, Meral Kayıkçıoğlu22
1 Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
2 Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
3Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
4 Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
5 Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla,Türkiye
6 Department 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

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.

Keywords: Diabetes mellitus, dyslipidemia, atherosclerosis, lipid guidelines, low-density lipoprotein cholesterol, cardiovascular risk

Özcan Başaran, Volkan Doğan, Kadir Uğur Mert, Bülent Özlek, Eda Özlek, Oğuzhan Çelik, Cem Çil, İbrahim Halil Özdemir, İbrahim Rencüzoğulları, Fatma Özpamuk Karadeniz, Mehmet Tekinalp, Lütfü Aşkın, Selami Demirelli, Erkan Gencer, Lütfü Bekar, Müjdat Aktaş, Mübariz Murat Resulzade, Macit Kalçık, Gökhan Aksan, Göksel Çinier, Kadriye Halil Akay, Nihat Pekel, Gurbet Özge Mert, Utku Şenol, Vahit Demir, Sinan İnci, Emir Derviş, Murat Biteker, Meral Kayıkçıoğlu. How Did the Updated 2019 European Society of Cardiology/European Atherosclerosis Society Risk Categorization for Patients with Diabetes Affect the Risk Perception and Lipid Goals? A Simulated Analysis of Real-life Data from EPHESUS Study. Anatol J Cardiol. 2023; 27(2): 78-87

Corresponding Author: Özcan Başaran
Manuscript Language: English


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