Author + information
- Dominik Lautsch,
- Anselm Gitt,
- Jean Ferrieres,
- Martin Horack,
- Philippe Brudi and
- Baishali Ambegaonkar
Background: Post acute coronary syndrome (ACS) patients with additional risk factors such as diabetes are at enhanced risk for future cardiovascular events. The current ACC lipid pathway guidance recommends a low density lipoprotein (LDL-C) threshold of <70 mg/dl or a 50% reduction for these patients. Based on real life data, we evaluated whether lipid lowering therapy (LLT) post ACS would be different in patients with concomitant diabetes.
Methods: DYSIS IIACS is a prospective observational study in Asia, Europe, and the Middle East. Adult patients were enrolled from May 2013-October 2014. They were hospitalized for an ACS event, had a full lipid profile available within 24 hours of hospital admission, were on LLT ≥ 3 months or not at all, alive at discharge, and not participating in clinical trials involving medication. Interviews were conducted at discharge and after 4 months, diabetes actively documented.
Results: 3867 ACS patients were enrolled of which 3803 could be included: mean age was 62.3±12.1 years; 76.4% were male. At inclusion, 23.8% of the patients with and 16% of the patients without diabetes reached LDL-C<70 mg/dl (p<0.0001). Median distance to target was 38 (16, 66) mg/dl in patients with versus 48 (24, 77) mg/dl in patients without diabetes. (p<0.0001). 91% of all patients were available for the interview after 4 months of which 28% had recent lab values. 37.5% of them suffering from diabetes. Patients with diabetes received statins in an atorvastatin equivalent dose of 33 ± 20 mg/day, those without diabetes 32 ± 22 mg/day (p<0.05) and ezetimibe in combination with a statin in 5.0% of the patients (ns.). There was no difference in combination with another non-statin (4.2% vs. 3.2%, ns.) or no treatment at all (4.8% vs. 4.2%).
Conclusions: Concomitant DM had no influence on the physicians’ LLT choice. Lower LDL-C in patients with DM could indicate a different LDL-C profile with smaller particles. LDL-C target value attainment was low in both groups. Clinical Implication: Enhanced focus in identification and treatment, including high intensity LLT, should be put on patients with severely increased cardiovascular risk.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Diabetes and Other Issues in Cardiovascular Prevention
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1277-060
- 2017 American College of Cardiology Foundation