Low-density lipoprotein cholesterol treatment and outcomes in patients with type 2 diabetes and established cardiovascular disease: Insights from TECOS.

Abstract

BACKGROUND:

Type 2 diabetes (T2D) patients are at increased risk for cardiovascular (CV) events. Most guidelines recommend treating low-density lipoprotein cholesterol (LDL-C) levels to ≤70 mg/dL (1.8 mM) for patients with T2D and established atherosclerotic CV disease, and some a more aggressive target of ≤55 mg/dL (1.4 mM). Our objective was to assess the degree to which these LDL-C targets are achieved in routine practice.

METHODS:

Using data from TECOS, an international pragmatic CV outcomes trial of sitagliptin vs placebo, we assessed lipid-lowering treatment among patients with T2D and CV disease, baseline lipid values, and the association between baseline LDL-C and 5-year risk for major adverse cardiac events (MACE; ie, CV death, nonfatal myocardial infarction, or nonfatal stroke).

RESULTS:

Overall, 11,066 of 14,671 TECOS participants (75.4%) had LDL-C measured at baseline. Median age was 65 years, 72% were male, and median T2D duration was 10 years. Overall, 82.5% of patients were on statins; only 5.8% were on ezetimibe. At baseline, 14.3% had LDL-C ≤55 mg/dL, 18.4% between 55.1 and 70 mg/dL, 35% between 70.1 and 100 mg/dL, and 32.3% >100 mg/dL. Each 10 mg/dL higher LDL-C value was associated with a higher risk of MACE (HR 1.05, 95% CI 1.03-1.07) or CV death (HR 1.06, 95% CI 1.04-1.09).

CONCLUSIONS:

Although most high-risk patients with T2D and CV disease were on lipid-lowering therapy, only 1:3 had LDL-C <70 mg/dL and 1:6 had LDL-C <55 mg/dL. Each 10 mg/dL higher LDL-C value was associated with a 5% and 6% higher 5-year incidence of MACE and CV death, respectively. (TECOS, NCT00790205).

• Authors: Gaetano M De Ferrari, Susanna R Stevens, Giuseppe Ambrosio, Sergio Leonardi, Paul W Armstrong, Jennifer B Green, Malgorzata Wamil, Rury R Holman, Eric D Peterson, TECOS Study Group
• Journal: American heart journal (Am Heart J) Vol. 220 Pg. 82-88 (02 2020) ISSN: 1097-6744 [Electronic] United States
• PMID: 31790905 (Publication Type: Journal Article, Multicenter Study, Pragmatic Clinical Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Chemical References

• Cholesterol, LDL
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Hypoglycemic Agents
• Ezetimibe
• Sitagliptin Phosphate

Topics

• Aged
• Atherosclerosis (blood, prevention & control)
• Cardiovascular Diseases (mortality)
• Cholesterol, LDL (blood)
• Diabetes Mellitus, Type 2 (blood, drug therapy)
• Double-Blind Method
• Ezetimibe (therapeutic use)
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Hypoglycemic Agents (therapeutic use)
• Male
• Middle Aged
• Myocardial Infarction (epidemiology)
• Reference Values
• Sitagliptin Phosphate (therapeutic use)
• Stroke (epidemiology)