scholarly journals Cholesterol lowering therapies and achievement of targets for primary and secondary cardiovascular prevention in type 2 diabetes: unmet needs in a large population of outpatients at specialist clinics

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Mario Luca Morieri ◽  
◽  
Angelo Avogaro ◽  
Gian Paolo Fadini
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Secondary Prevention ◽  
Large Population ◽  
Cardiovascular Prevention ◽  
Response To Treatment ◽  
Pcsk9 Inhibitors ◽  
Esc Guidelines ◽  
Very High

Abstract Background The well-established benefit of Low-Dense-Lipoprotein-cholesterol (LDL-c) lowering treatments (LLTs) has led clinical guidelines to lower the cardiovascular prevention targets. Despite this, there is a surprising scarcity of real-world studies (RWS) evaluating whether recommendations are applied in the routine clinical management of patients with type 2 diabetes (T2D). We therefore evaluated, in a large RWS, the pattern of LLTs use and the achievement of LDL-c targets in patients with T2D in Italian diabetes specialist clinics. Methods We collected data from 46 diabetes outpatient clinics (following 281,381 subjects), including 104,726 T2D patients, for whom use of LLTs between 2015 and 2016 was ascertained. We used the 2016 and 2019 European Atherosclerosis Society and European Society of Cardiology (EAS-ESC) guidelines to define cardiovascular risk categories, LDL-c targets, and the expected LDL-c reduction and cardiovascular benefit achievable with LLT intensification. Results 63,861 patients (61.0%) were on statin therapy, 9.2% of whom were also on ezetimibe. Almost all subjects were at high (29.3%) or very high (70.4%) cardiovascular risk, including 17% being in secondary prevention. Among very high-risk patients, 35% were not on statin despite half of them had LDL-c > 2.6 mmol/l, and only 15% of those on statins had LDL-c < 1.4 mmol/l. 83% of subjects in secondary prevention were on a statin, but half of them had LDL-c > 1.8 mmol/l. Overall, 35% and 14% of subjects achieved the LDL-c targets as suggested by 2016 and 2019 EAS-ESC Guidelines, respectively. Based on anticipated response to treatment, we estimated that 38% of the entire population would require high-intensity-statin (HI-statin), 27% a combination of HI-statin plus ezetimibe, and 27% the addition of proprotein-convertase-subtilisin/kexin-9 (PCSK9) inhibitors. These LLT intensifications would reduce the incidence of cardiovascular events by 32%, from 23.511 to 16.022 events per 100.000 patients/10-years (incidence-rate-ratio 0.68; 95% C.I 0.67–0.70, p < 0.001). Conclusions Despite the increase in use of LLT in T2D over the last decades, a large proportion of subjects with T2D did not achieve their LDL-c targets. Given the very high cardiovascular risk of these patients, improving LLT is expected to have a dramatic impact on cardiovascular event prevention.

scholarly journals Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Basilio Pintaudi ◽  
Alessia Scatena ◽  
Gabriella Piscitelli ◽  
Vera Frison ◽  
Salvatore Corrao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
High Cardiovascular Risk ◽  
Very High

Abstract Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.

scholarly journals The Impact of Triglyceride-Glucose Index On Incident Cardiovascular Events in Patients With Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Liyao Fu ◽  
Shi Tai ◽  
Jiaxing Sun ◽  
Ningjie Zhang ◽  
Ying Zhou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Risk ◽  
Tyg Index ◽  
Accord Study ◽  
The Impact ◽  
Very High

Abstract Background: Previous studies reported the prognostic value of the triglyceride-glucose (TyG) index in the course of cardiovascular (CV) diseases. Still, it remains unclear whether baseline and trajectories of TyG index are prospectively associated with incident CV events among patients with type 2 diabetes mellitus (T2DM).Methods: We performed a secondary analysis in patients with long-lasting T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The primary outcome was the first occurrence of adverse CV events including nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes, and the TyG index was measured at 11 visits. Cox proportional hazards regression analysis was used to observe the association between baseline and trajectories of TyG index and adverse CV outcomes.Results: During a median follow-up period of 8.8 years, 1,815 (17.8%) developed at least one primary endpoint event. After adjusting for traditional cardiovascular risk factors, each 1-SD increase in the TyG index was associated with a 19.00% higher risk of adverse CV events, similar in individuals categorized by TyG index quartiles. Four distinct trajectories of TyG indexes were identified- low (16.17%), moderate (40.01%), high (34.60%), and very high (9.30%). Among these, moderate, high, and very high TyG index trajectories had a greater risk of future incident adverse CV events than low TyG index trajectories after multivariate adjustments for traditional risk factors. Particularly, a similar association was noticed in the TyG index and the occurrence of coronary heart disease.Conclusions: The findings of this study suggest that both baseline and trajectories of TyG index have a significant association with the occurrence of adverse CV events in patients with T2DM. (Trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620)

Pharmacological Management of Cardiac Disease in Patients with Type 2 Diabetes: Insights into Clinical Practice

2020 ◽  
Vol 18 (2) ◽  
pp. 125-138 ◽  
Author(s):  
Dimitrios Patoulias ◽  
Konstantinos Stavropoulos ◽  
Konstantinos Imprialos ◽  
Vasilios Athyros ◽  
Michael Doumas ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Secondary Prevention ◽  
New Drugs ◽  
Therapeutic Interventions ◽  
Diabetic Patients ◽  
Primary And Secondary Prevention ◽  
Pcsk9 Inhibitors ◽  
Pharmacological Management ◽  
Major Health Problem

Background: Type 2 Diabetes Mellitus (T2DM) has emerged as a growing pandemic. Cardiovascular disease (CVD) constitutes another major health problem, with coronary heart disease being the leading cause of cardiovascular death. Patients with T2DM require a multilevel therapeutic approach, both for primary and secondary prevention of CVD. Objective: To present and summarize the most recent, highest level evidence retrieved from literature, relevant to the pharmaceutical management of CVD in T2DM. Method: We conducted a comprehensive search of the literature on MEDLINE from its inception till today, primarily for relevant systematic reviews, meta-analyses and randomized controlled trials. Results: There is a trend towards more intensified therapeutic interventions in T2DM, concerning glycemic, lipid and blood pressure control. New drugs, such as sodium-glucose co-transporter 2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors might evolve as key players in the management of diabetes and its complications within the next years. Classic drugs, such as those targeting the renin-angiotensinaldosterone system, statins and aspirin remain first-line treatment options, both for primary and secondary prevention of CVD. Lifestyle interventions should always be integrated into a complete therapeutic strategy in diabetic patients. Novel drugs, such as finerenone and LCZ696 have provided significant results in cardiovascular outcome studies; however, their role in T2DM has to be further elucidated. Conclusion: Pharmaceutical approach of CVD in T2DM is multilevel and complex. Drug classes featuring pleiotropic effects may boost our armamentarium in the fight against CVD.

scholarly journals Evaluation of the HbA1c Reduction Cut Point for a Nonglycemic Effect on Cardiovascular Benefit of Hypoglycemic Agents in Patients with Type 2 Diabetes Based on Endpoint Events

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yuchao Wu ◽  
Lizhi Tang ◽  
Fang Zhang ◽  
Zhe Yan ◽  
Jing Li ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Prevention ◽  
High Risk ◽  
Secondary Prevention ◽  
Glucose Control ◽  
Hypoglycemic Agents ◽  
Intensive Glucose Control ◽  
Very High ◽  
Cardiovascular Benefit

Background. Atherosclerotic cardiovascular disease (ASCVD) is a major cause of death among patients with diabetes but can be improved by certain hypoglycemic agents. However, adjudicating criteria on whether improvements are a glycemic or nonglycemic effect of these agents remain unclear. Methods. Hypoglycemic agents that produce a cardiovascular benefit in nondiabetic patients are considered to do so via a nonglycemic effect. We performed a subgroup analysis for primary and secondary prevention or very high risk of ASCVD in patients with type 2 diabetes (T2DM). Where glycosylated hemoglobin (HbA1c) was reduced to the same extent in a head-to-head comparison, cardiovascular benefits were judged as a nonglycemic effect. Furthermore, by analyzing the endpoints of four important randomized controlled intensive glucose control studies, UKPDS33, ADVANCE, ACCORD, and VADT, we calculated the cut point of HbA1c reduction for a nonglycemic effect on cardiovascular benefit by hypoglycemic agents in ASCVD groups of different severities. Results. For the ASCVD primary prevention group of T2DM, UKPDS33 indicated a reduction in HbA1c < 0.9%, and a cardiovascular benefit within 10 years was considered a nonglycemic effect. For ASCVD secondary prevention or in the very high-risk group, pioglitazone exerted a nonglycemic effect on cardiovascular benefit in nondiabetic patients with insulin resistance; metformin may exert a similar effect in T2DM patients in a head-to-head study. Analysis of T2DM intensive glucose control studies showed a reduction in HbA1c of <1.0%, and a cardiovascular benefit after approximately 5 years was deemed a nonglycemic effect. Conclusions. For ASCVD primary prevention in T2DM, a reduction in HbA1c < 0.9% and a cardiovascular benefit within 10 years were considered a nonglycemic effect. For ASCVD secondary prevention or in a very high-risk population, a reduction in HbA1c < 1.0% and a cardiovascular benefit within about 5 years were also considered a nonglycemic effect.

scholarly journals Effects of dapagliflozin of the markers of fibrosis and inflammation in type 2 diabetes and very high cardiovascular risk

2021 ◽  
Vol 5 (4) ◽  
pp. 185-188
Author(s):  
D.A. Lebedev ◽  
◽  
A.Yu. Babenko ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Randomized Clinical Trials ◽  
High Sensitivity ◽  
Type I ◽  
High Cardiovascular Risk ◽  
Renal Outcomes ◽  
Positive Effects ◽  
Very High

Background: several randomized clinical trials have demonstrated that dapagliflozin, like other inhibitors of sodium-glucose cotransporter 2 (SGLT2), significantly improves cardiovascular and renal outcomes in type 2 diabetes (T2D). However, underlying mechanisms remain unclear. Aim: to assess changes in the levels of serum markers associated with fibrosis and inflammation in patients with T2D receiving dapagliflozin. Patients and Methods: this prospective single-center study included 27 patients aged 40–65 years with T2D that lasts more than 1 year and without verified atherosclerosis but multiple cardiovascular risk factors (i.e., dyslipidemia, obesity, hypertension). In addition to basic treatment for T2D, all patients received dapagliflozin 10 mg daily for 6 months. Before and 6 months after treatment, the levels of the markers of fibrosis (including procollagen type I carboxy-terminal propeptide/PICP) and inflammation were measured. Results: the median age was 56 [49; 61] years and the median duration of T2D was 7 [4; 12] years. After 6-month treatment with dapagliflozin, significant reduction in the concentration of PICP from 136.8 [100,4; 200,6] ng/ml to 104.8 [79.7; 162.0] ng/ml (р = 0.019). The levels of galectin-3, matrix metalloproteinase (MMP) 9, tissue inhibitor of MMP-1, growth stimulating expressed gene 2, high-sensitivity C-reactive protein, and N-terminal pro-atrial natriuretic peptide were similar at baseline and after 6-month treatment. Conclusions: 6-month treatment with dapagliflozin reduced the levels of PICP. Together with other mechanisms, this phenomenon illustrates the positive effects of dapagliflozin on cardiovascular and renal outcomes in T2D. KEYWORDS: type 2 diabetes, fibrosis, chronic inflammation, dapagliflozin, cardiovascular diseases. FOR CITATION: Lebedev D.A., Babenko A.Yu. Effects of dapagliflozin of the markers of fibrosis and inflammation in type 2 diabetes and very high cardiovascular risk. Russian Medical Inquiry. 2021;5(4):185–188 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-185-188.

Estudio Transversal: Riesgo Cardiovascular en Diabetes Mellitus II según Score UKPDS en pacientes del Hospital José Carrasco Arteaga

2020 ◽  
Vol 12 (3) ◽  
pp. 178-187
Author(s):  
Paola Cristina Bacuilima Zhañay ◽  
Andrea Catalina Ochoa Bravo
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Glycemic Control ◽  
Diabetic Patients ◽  
Clinical Records ◽  
Very High

BACKGROUND: Type 2 Diabetes Mellitus (DM2) is a disease of great health and socioeconomic impact. Cardiovascular complications are the main cause of death in diabetic patients, for this reason the application of prevention strategies is important. The aim of the research was to determine the cardiovascular risk according to UKPDS Score in patients diagnosed with DM2, treated at Hospital José Carrasco Arteaga, Cuenca-Ecuador, from November 2918 to August 2019. METHODS:A descriptive, cross-sectional study was conducted with a sample of 118 patients diagnosed with DM2, treated at Hospital José Carrasco Arteaga, between November 2018 and August 2019. Clinical records were reviewed, information was collected on a form with all the variables of the UKPDS Score. Cardiovascular Risk Estimation (RCV) was carried out with the Risk Engine Calculator version 2.0 of the UKPDS Score. RESULTS: The female sex predominated in the study population. The age range went from 32 to 95 years old, the most frequent range of age was 55 to 59 years old (16.1%). The disease duration in 40% of the population was higher than 10 years. 42.4 %(n=50) presented SBP values ≥130mmHg. 75.4% of the sample had poor glycemic control, with glycosylated hemog-lobin levels higher than the normal range for each age group. The estimated 5-year CVR was low for most of the sample; while the 10 year CVR increased, especially for non-fatal CVD(high risk:21.25%) and for fatal (6.8%) and non-fatal(6.8%) AMI. CONCLUSION:Most of the patients had more than 10 years with DMII diagnosis. More than half of the sample had inadequate glycemic control. The CVR at 5 years was “low” for the majority of the population, both for AMI and CVD. The cardiovascular risk at 10 years was slightly higher for all entities, especially it increases for non-fatal CVD, to a “very high risk” of 21.2%, and the risk of AMI also increases to a “very high risk” of 6.8%. KEYWORDS: TYPE 2 DIABETES MELLITUS, CARDIOVASCULAR DISEASES, MYOCARDIAL INFARCTION, CEREBROVASCULAR STROKE

Use of Statins and Gemfibrozil in Patients with Type 2 Diabetes Mellitus and Cardiovascular Risk Factors Attending Adult Day Health Care Centers: An Opportunity for Pharmacists Research and Reports

2007 ◽  
Vol 22 (1) ◽  
pp. 38-44 ◽  
Author(s):  
Jack Rosenberg ◽  
Tina Zerilli ◽  
Joseph Nathan ◽  
Howard Mcguire
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Cardiovascular Risk Factors ◽  
Adult Day Health Care ◽  
Health Care Centers

Objective: Identify the extent of statin use for primary prevention of macrovascular complications, the extent of statin or gemfibrozil use for the secondary prevention of cardiovascular morbidity and mortality, and the statin doses used in patients with type 2 diabetes and other cardiovascular risk factors.Design: Retrospective chart review.Setting: Three adult day health care centers in Brooklyn and Queens, New York.Patients: Patients with a diagnosis of type 2 diabetes and either a history of coronary artery disease or at least one other significant cardiovascular risk factor as defined by the American College of Physicians guidelines (i.e., age greater than 55 years, hypertension, left-ventricular hypertrophy, previous cerebrovascular disease, or peripheral arterial disease).Main Outcome Measures: Percentage of patients prescribed a statin for primary prevention of macrovascular complications of type 2 diabetes, percentage of patients prescribed a statin or gemfibrozil for secondary prevention of cardiovascular mortality and morbidity, and the percentage of patients on at least moderate doses of statins.Results: Ninety-three patients were evaluated—51 in the primary-prevention group and 42 in the secondary-prevention group. In the primary-prevention group, 33 (64.7%) patients were prescribed a statin, while in the secondary-prevention group, 26 (61.9%) patients were on statins, a nonsignificant difference (P = 0.8308). No patients were prescribed gemfibrozil. Of all patients prescribed statins, 63.2% were at least on moderate doses.Conclusion: This study demonstrates suboptimal treatment with statins in patients with type 2 diabetes and cardiovascular risk factors.

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