W01.46 Relation of markers of inflammation and effect of statin therapy in diabetic patients

Dyslipidaemia contributes to endothelial dysfunction and CVD (cardiovascular disease) in Type 2 diabetes mellitus. While statin therapy reduces CVD in these patients, residual risk remains high. Fenofibrate corrects atherogenic dyslipidaemia, but it is unclear whether adding fenofibrate to statin therapy lowers CVD risk. We investigated whether fenofibrate improves endothelial dysfunction in statin-treated Type 2 diabetic patients. In a cross-over study, 15 statin-treated Type 2 diabetic patients, with LDL (low-density lipoprotein)-cholesterol <2.6 mmol/l and endothelial dysfunction [brachial artery FMD (flow-mediated dilatation) <6.0%] were randomized, double-blind, to fenofibrate 145 mg/day or matching placebo for 12 weeks, with 4 weeks washout between treatment periods. Brachial artery FMD and endothelium-independent NMD (nitrate-mediated dilatation) were measured by ultrasonography at the start and end of each treatment period. PIFBF (post-ischaemic forearm blood flow), a measure of microcirculatory endothelial function, and serum lipids, lipoproteins and apo (apolipoprotein) concentrations were also measured. Compared with placebo, fenofibrate increased FMD (mean absolute 2.1±0.6 compared with −0.3±0.6%, P=0.04), but did not alter NMD (P=0.75). Fenofibrate also increased maximal PIFBF {median 3.5 [IQR (interquartile range) 5.8] compared with 0.3 (2.1) ml/100 ml/min, P=0.001} and flow debt repayment [median 1.0 (IQR 3.5) compared with −1.5 (3.0) ml/100 ml, P=0.01]. Fenofibrate lowered serum cholesterol, triacylgycerols (triglycerides), LDL-cholesterol, apoB-100 and apoC-III (P≤0.03), but did not alter HDL (high-density lipoprotein)-cholesterol or apoA-I. Improvement in FMD was inversely associated with on-treatment LDL-cholesterol (r=−0.61, P=0.02) and apoB-100 (r=−0.54, P=0.04) concentrations. Fenofibrate improves endothelial dysfunction in statin-treated Type 2 diabetic patients. This may relate partly to enhanced reduction in LDL-cholesterol and apoB-100 concentrations.

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Abstract 184: Quality Improvement of Statin Therapy Appropriateness in Type 2 Diabetic Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.184 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Dan L Li ◽

Erika Diaz Narvaez ◽

Chioma Onyekwelu ◽

Eleanor M Weinstein ◽

Robert T Faillace

Keyword(s):

Quality Improvement ◽

Statin Therapy ◽

High Intensity ◽

Quality Improvement Project ◽

Planning System ◽

Diabetic Patients ◽

Improvement Project ◽

Medicine Clinic ◽

Ascvd Risk ◽

Statin Dose

Objectives: The 2013 ACC/AHA guidelines recommend statin therapy for all diabetic patients between the ages of 40 to 75. The intensity of statin therapy is guided by the 10-year atherosclerosis cardiovascular disease (ASCVD) risk for a given patient. A quality-improvement project was carried out in the Jacobi Medical Center (JMC) Primary Care Medicine clinic to help clinicians improve statin therapy appropriateness. Interventions included: Intense education to house staff and clinic faculty members beginning in November 2015; Establishment of a pre-visit planning system beginning in August 2016 whereby nursing staff would preview the lipid panel of diabetic patients and alert providers when the LDL was above 100 mg/dl. A retrospective study was carried out to evaluate statin therapy appropriateness before and after this quality improvement project. Methods: Type 2 Diabetes Mellitus (T2DM) patients (age between 40-75) were selected from the JMC Medicine Clinic visits in September 2015 (baseline), May 2016 (after intense education), and September 2016 (after launching the pre-visit planning system). Exclusion criteria included: heart failure, ESRD on hemodialysis, active malignancy, and missing information for ASCVD risk calculation. In patients with LDL > 70 and with no history of CVD, the 10-year ASCVD risk was calculated and statin appropriateness was determined by comparing the actual statin prescription with the statin intensity suggested by the 2013 ACC/AHA guidelines. For patients who had an established diagnosis of CVD, statin therapy appropriateness was evaluated by whether the patients were on high-intensity statin therapy. Comparisons among groups were performed using chi-square analysis. Results: The numbers of patients in each of the three months after the exclusions were 371, 346 and 358; among which, 68, 70 and 77 patients had existing CVD respectively. Overall, 38.8% of the patients seen in September 2015 were prescribed an appropriate statin dose; the number rose to 42.2% in May 2016, and further to 50.0% in September 2016 ( p = 0.0086). For primary prevention of CVD, 35.3% of patients received an appropriate statin dose in September 2015; this number improved to 38.5% in May 2016, after intense education; and to 44.2% in September 2016. ( p = 0.089) For secondary prevention of CVD events in patients with clinical CVD, 54.4% of the patients in September 2015 were given high-intensity statins. The high-intensity statin prescription rate was 57.1% in May 2016, and subsequently increased to 70.1% in September 2016. ( p = 0.11) Conclusions: Significant improvement in compliance with the 2013 ACC/AHA guideline-based statin dose for lipid management in the JMC Primary Care Medicine Clinic was found to be associated with the implementation of a quality-improvement project consisting of intense physician education and a pre-visit planning system.

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Abstract 174: Healthcare Provider Compliance with the 2013 ACC/AHA Blood Cholesterol Guidelines for Statin Therapy for Diabetic Patients of Ages 40 to 75

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.12.suppl_1.174 ◽

2019 ◽

Vol 12 (Suppl_1) ◽

Author(s):

Ahmed Saleh ◽

Sarju Ganatra ◽

Sherif Labib

Keyword(s):

Statin Therapy ◽

Healthcare Provider ◽

Blood Cholesterol ◽

Diabetic Patients ◽

Cholesterol Guidelines

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A new approach to the treatment of dyslipidemia

Medicina ◽

10.3390/medicina44050053 ◽

2008 ◽

Vol 44 (5) ◽

pp. 407 ◽

Cited By ~ 4

Author(s):

Sigita Kėvelaitienė ◽

Rimvydas Šlapikas

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Diseases ◽

High Risk ◽

Statin Therapy ◽

Cholesterol Absorption ◽

Diabetic Patients ◽

Intestinal Cholesterol Absorption ◽

Beneficial Effects ◽

European Society Of Cardiology

During the last decade, the evidence of beneficial effects of cholesterol lowering in patients with coronary heart disease has been proven in many clinical trials. The National Cholesterol Education Program (NCEP) released 2004 update to the Adult Treatment Panel III (ATP III) guidelines. The new guidelines of European Society of Cardiology announced in 2007 support more intensive LDL-C lowering in patients at high risk of cardiovascular diseases. For patients at the highest risk of cardiovascular diseases (diabetic patients with coronary heart disease), the recommended LDL-C goal is <1.8 mmol/L. In very high-, high-, and moderately high-risk patients, statin therapy should be considered with a treatment targeting an LDL-C reduction of 30– 40%. Clinical studies have shown that statin therapy alone is not always effective, especially in patients with primary hypercholesterolemia. Furthermore, high doses of statins can increase the possibility of adverse events. The combination of statins with intestinal cholesterol absorption inhibitors is more effective than statin monotherapy in LDL-C lowering and is well tolerated.

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Increased plasma markers of inflammation and endothelial dysfunction and their association with microvascular complications in Type 1 diabetic patients without clinically manifest macroangiopathy

Diabetic Medicine ◽

10.1111/j.1464-5491.2005.01562.x ◽

2005 ◽

Vol 22 (8) ◽

pp. 999-1004 ◽

Cited By ~ 76

Author(s):

G. Targher ◽

L. Bertolini ◽

G. Zoppini ◽

L. Zenari ◽

G. Falezza

Keyword(s):

Endothelial Dysfunction ◽

Microvascular Complications ◽

Diabetic Patients ◽

Markers Of Inflammation ◽

Type 1 Diabetic Patients ◽

Plasma Markers

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Markers of inflammation and endothelial dysfunction are associated with incident cardiovascular disease, all-cause mortality, and progression of coronary calcification in type 2 diabetic patients with microalbuminuria

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2015.11.005 ◽

2016 ◽

Vol 30 (2) ◽

pp. 248-255 ◽

Cited By ~ 31

Author(s):

Bernt Johan von Scholten ◽

Henrik Reinhard ◽

Tine Willum Hansen ◽

Casper G. Schalkwijk ◽

Coen Stehouwer ◽

...

Keyword(s):

Cardiovascular Disease ◽

Endothelial Dysfunction ◽

Coronary Calcification ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Markers Of Inflammation ◽

All Cause Mortality ◽

Incident Cardiovascular Disease ◽

Type 2 Diabetic

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The Challenge of Lipid Management in Patients with Diabetes or Other Endocrine Disorders

European Endocrinology ◽

10.17925/ee.2011.07.02.92 ◽

2010 ◽

Vol 7 (2) ◽

pp. 92

Author(s):

Alberico L Catapano ◽

Liliana Grigore ◽

Angela Pirillo ◽

◽

...

Keyword(s):

Statin Therapy ◽

Meta Analysis ◽

Diabetic Patients ◽

Endocrine Disorders ◽

Lipid Management ◽

Increased Risk ◽

Patients With Diabetes ◽

Associated Risk Factors

Diabetes increases the risk of developing cardiovascular disease (CVD), and several guidelines suggest that subjects with diabetes are at high risk of developing CVD. The increased risk can be attributed, at least in part, to associated risk factors, including hypertension and dyslipidaemia. The role of statins in primary and secondary prevention of CVD is well established, and the positive effect has been clearly demonstrated also in patients with type 2 diabetes. A number of studies have evaluated the effect of statin therapy on incident CVD and shown that statin therapy produces a great reduction in cardiovascular risk, but a recent meta-analysis revealed a slight increase in the risk of developing diabetes. Such risk is, however, low, especially when compared with the reduction in cardiovascular events and should not interfere with the choice of treating diabetic patients with a cholesterol-lowering therapy.

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