TY - JOUR
T1 - Low-density lipoprotein cholesterol treatment and outcomes in patients with type 2 diabetes and established cardiovascular disease
T2 - Insights from TECOS
AU - On behalf of the TECOS Study Group
AU - De Ferrari, Gaetano M.
AU - Stevens, Susanna R.
AU - Ambrosio, Giuseppe
AU - Leonardi, Sergio
AU - Armstrong, Paul W.
AU - Green, Jennifer B.
AU - Wamil, Malgorzata
AU - Holman, Rury R.
AU - Peterson, Eric D.
N1 - Funding Information:
Dr De Ferrari has served on an advisory board and speaker's bureau for Merck, has received grants from and served on an advisory board and speaker's bureau for Amgen, and served on an advisory board and speaker's bureau for Sanofi. Ms Stevens has no disclosures. Dr Ambrosio has served on an advisory board and speaker's bureau for Merck. Dr Leonardi has no disclosures. Dr Armstrong has received research grants, personal fees and non-financial support from Merck; complete disclosure available at http://thecvc.ca/wp-content/uploads/2017/01/Financial-Disclosure-form-PWA-September2018-Final.pdf . Dr Green has received grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Sanofi; and personal fees from AstraZeneca, Merck, Boehringer-Ingelheim, and NovoNordisk. Dr Wamil has no disclosures. Dr Holman has received grants from AstraZeneca, Bayer AG, and Merck Sharp & Dohme, as well as personal fees from Amgen, Bayer AG, Boehringer Ingelheim, Novo Nordisk, and Servier. Dr Peterson has received grant support from Janssen, Merck, Sanofi, AstraZeneca, Genentech, and Amgen; and has consulting associations with Bayer, Merck, Sanofi, and Janssen.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/2
Y1 - 2020/2
N2 - 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).
AB - 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).
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U2 - 10.1016/j.ahj.2019.11.005
DO - 10.1016/j.ahj.2019.11.005
M3 - Article
C2 - 31790905
AN - SCOPUS:85075616379
VL - 220
SP - 82
EP - 88
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -